hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|KS,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Southwest Medical Center,4/1/2024,2.0.0,Southwest Medical Center,"315 W 15th st Liberal, KS 67901",480684878,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA MEDICAID PLAN,AETNA MEDICAID REIMBURSEMENT METHOD,BLUE CROSS BLUE SHIELD KANSAS PLAN,BLUE CROSS BLUE SHIELD KANSAS REIMBURSEMENT METHOD,COVENTRY AETNA PLAN,COVENTRY AETNA REIMBURSEMENT METHOD,HEALTH CHOICE PLAN,HEALTH CHOICE REIMBURSEMENT METHOD,MULTIPLAN PHCS AUTO PLAN,MULTIPLAN PHCS AUTO REIMBURSEMENT METHOD,MULTIPLAN PHCS COMPLEMENTARY NETWORK  PLAN,MULTIPLAN PHCS COMPLEMENTARY NETWORK  REIMBURSEMENT METHOD,MULTIPLAN PHCS MEDICAID  plan,MULTIPLAN PHCS MEDICAID  REIMBURSEMENT METHOD,MULTIPLAN PHCS MEDICAL ASSISTANCE PROGRAM plan,MULTIPLAN PHCS MEDICAL ASSISTANCE PROGRAM REIMBURSEMENT METHOD,MULTIPLAN PHCS PRIMARY NETWORK plan,MULTIPLAN PHCS PRIMARY NETWORK REIMBURSEMENT METHOD,NATIONAL BEEF PACKING plan,NATIONAL BEEF PACKING REIMBURSEMENT METHOD,OMNI NETWORK plan,OMNI NETWORK REIMBURSEMENT METHOD,SUNFLOWER KS MEDICAID  plan,SUNFLOWER KS MEDICAID  REIMBURSEMENT METHOD,UNITED HEALTHCARE COMMERCIAL plan,UNITED HEALTHCARE COMMERCIAL REIMBURSEMENT METHOD,UNITED HEALTHCARE MEDICAID plan,UNITED HEALTHCARE MEDICAID REIMBURSEMENT METHOD,UNITED HEALTHCARE MEDICARE  plan,UNITED HEALTHCARE MEDICARE  REIMBURSEMENT METHOD,WPPA plan,WPPA REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94640,Breathing Treatment,412,$207.00 ,$12.88 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$41.36 ,100% of BCBS Fee schedule for outpatient setting,$22.46 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$144.90 ,70% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$192.51 ,93% of total billed charges for outpatient setting,$13.01 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.01 ,101% Medicaid OPPS fee schedule for outpatient setting,$175.95 ,85% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$12.88 ,100% Medicaid OPPS fee schedule for outpatient setting,$180.09 ,87% of total billed charges for outpatient setting,$12.88 ,100% Medicaid OPPS fee schedule for outpatient setting,$171.24 ,pay at 100% of APC for outpatient setting,$144.90 ,70% of total billed charges for outpatient setting,$12.88 ,$192.51 ,$165.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94664,Breathing Treatment Demo/Eval,412,$47.50 ,$22.43 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$34.86 ,100% of BCBS Fee schedule for outpatient setting,$34.21 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$33.25 ,70% of total billed charges for outpatient setting,$42.75 ,90% of total billed charges for outpatient setting,$44.18 ,93% of total billed charges for outpatient setting,$22.65 ,101% Medicaid OPPS fee schedule for outpatient setting,$22.65 ,101% Medicaid OPPS fee schedule for outpatient setting,$40.38 ,85% of total billed charges for outpatient setting,$42.75 ,90% of total billed charges for outpatient setting,$42.75 ,90% of total billed charges for outpatient setting,$22.43 ,100% Medicaid OPPS fee schedule for outpatient setting,$41.33 ,87% of total billed charges for outpatient setting,$22.43 ,100% Medicaid OPPS fee schedule for outpatient setting,$171.24 ,pay at 100% of APC for outpatient setting,$33.25 ,70% of total billed charges for outpatient setting,$22.43 ,$171.24 ,$38.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93798,Cardiac Rehab w/EKG monitor,943,$355.50 ,$27.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$81.15 ,100% of BCBS Fee schedule for outpatient setting,$28.91 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$248.85 ,70% of total billed charges for outpatient setting,$319.95 ,90% of total billed charges for outpatient setting,$330.62 ,93% of total billed charges for outpatient setting,$28.09 ,101% Medicaid OPPS fee schedule for outpatient setting,$28.09 ,101% Medicaid OPPS fee schedule for outpatient setting,$302.18 ,85% of total billed charges for outpatient setting,$319.95 ,90% of total billed charges for outpatient setting,$319.95 ,90% of total billed charges for outpatient setting,$27.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$309.29 ,87% of total billed charges for outpatient setting,$27.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$107.36 ,pay at 100% of APC for outpatient setting,$248.85 ,70% of total billed charges for outpatient setting,$27.81 ,$330.62 ,$284.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93306,Echocardiogram,483,"$3,159.00 ",$366.85 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,517.00 ",100% of BCBS Fee schedule for outpatient setting,$417.05 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,211.30 ",70% of total billed charges for outpatient setting,"$2,843.10 ",90% of total billed charges for outpatient setting,"$2,937.87 ",93% of total billed charges for outpatient setting,$370.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$370.52 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,685.15 ",85% of total billed charges for outpatient setting,"$2,843.10 ",90% of total billed charges for outpatient setting,"$2,843.10 ",90% of total billed charges for outpatient setting,$366.85 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,748.33 ",87% of total billed charges for outpatient setting,$366.85 ,100% Medicaid OPPS fee schedule for outpatient setting,$449.91 ,pay at 100% of APC for outpatient setting,"$2,211.30 ",70% of total billed charges for outpatient setting,$366.85 ,"$2,937.87 ","$2,527.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,C8929,Echocardiogram w/contrast,483,"$3,260.00 ",N/A,Not separately reimbursable per CMS guidelines,"$1,517.00 ",Not separately reimbursable per CMS guidelines,"$2,608.00 ",80% of total billed charges for outpatient setting,"$2,282.00 ",70% of total billed charges for outpatient setting,"$2,934.00 ",90% of total billed charges for outpatient setting,"$3,031.80 ",93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$2,771.00 ",85% of total billed charges for outpatient setting,"$2,934.00 ",90% of total billed charges for outpatient setting,"$2,934.00 ",90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$2,836.20 ",87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$662.39 ,pay at 100% of APC for outpatient setting,"$2,282.00 ",70% of total billed charges for outpatient setting,$662.39 ,"$3,031.80 ","$2,608.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93005,EKG Routine,730,$385.00 ,$19.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$12.10 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$269.50 ,70% of total billed charges for outpatient setting,$346.50 ,90% of total billed charges for outpatient setting,$358.05 ,93% of total billed charges for outpatient setting,$19.27 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.27 ,101% Medicaid OPPS fee schedule for outpatient setting,$327.25 ,85% of total billed charges for outpatient setting,$346.50 ,90% of total billed charges for outpatient setting,$346.50 ,90% of total billed charges for outpatient setting,$19.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$334.95 ,87% of total billed charges for outpatient setting,$19.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$51.39 ,pay at 100% of APC for outpatient setting,$269.50 ,70% of total billed charges for outpatient setting,$12.10 ,$358.05 ,$308.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93270,"Event Monitor Recording, Transmission",731,$918.50 ,$37.31 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$118.73 ,100% of BCBS Fee schedule for outpatient setting,$16.92 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$642.95 ,70% of total billed charges for outpatient setting,$826.65 ,90% of total billed charges for outpatient setting,$854.21 ,93% of total billed charges for outpatient setting,$37.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$37.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$780.73 ,85% of total billed charges for outpatient setting,$826.65 ,90% of total billed charges for outpatient setting,$826.65 ,90% of total billed charges for outpatient setting,$37.31 ,100% Medicaid OPPS fee schedule for outpatient setting,$799.10 ,87% of total billed charges for outpatient setting,$37.31 ,100% Medicaid OPPS fee schedule for outpatient setting,$31.29 ,pay at 100% of APC for outpatient setting,$642.95 ,70% of total billed charges for outpatient setting,$16.92 ,$854.21 ,$734.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93225,"Holter Scanning, Recording",731,"$1,751.00 ",$50.14 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$186.41 ,100% of BCBS Fee schedule for outpatient setting,$39.05 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,225.70 ",70% of total billed charges for outpatient setting,"$1,575.90 ",90% of total billed charges for outpatient setting,"$1,628.43 ",93% of total billed charges for outpatient setting,$50.64 ,101% Medicaid OPPS fee schedule for outpatient setting,$50.64 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,488.35 ",85% of total billed charges for outpatient setting,"$1,575.90 ",90% of total billed charges for outpatient setting,"$1,575.90 ",90% of total billed charges for outpatient setting,$50.14 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,523.37 ",87% of total billed charges for outpatient setting,$50.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.82 ,pay at 100% of APC for outpatient setting,"$1,225.70 ",70% of total billed charges for outpatient setting,$39.05 ,"$1,628.43 ","$1,400.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94761,Oximetry,410,$517.50 ,$19.62 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$16.97 ,100% of BCBS Fee schedule for outpatient setting,$6.56 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$362.25 ,70% of total billed charges for outpatient setting,$465.75 ,90% of total billed charges for outpatient setting,$481.28 ,93% of total billed charges for outpatient setting,$19.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$439.88 ,85% of total billed charges for outpatient setting,$465.75 ,90% of total billed charges for outpatient setting,$465.75 ,90% of total billed charges for outpatient setting,$19.62 ,100% Medicaid OPPS fee schedule for outpatient setting,$450.23 ,87% of total billed charges for outpatient setting,$19.62 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$362.25 ,70% of total billed charges for outpatient setting,$6.56 ,$481.28 ,$414.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94660,Pressurized Respiratory Assist / BIPAP/CPAP/VAPOTHERM,410,$932.50 ,N/A,Not separately reimbursable per CMS guidelines,$267.86 ,Not separately reimbursable per CMS guidelines,$79.64 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$652.75 ,70% of total billed charges for outpatient setting,$839.25 ,90% of total billed charges for outpatient setting,$867.23 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$792.63 ,85% of total billed charges for outpatient setting,$839.25 ,90% of total billed charges for outpatient setting,$839.25 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$811.28 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$171.24 ,pay at 100% of APC for outpatient setting,$652.75 ,70% of total billed charges for outpatient setting,$79.64 ,$867.23 ,$746.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,95810,Sleep Lab,920,"$6,353.50 ",$146.70 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,046.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,252.90 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$4,447.45 ",70% of total billed charges for outpatient setting,"$5,718.15 ",90% of total billed charges for outpatient setting,"$5,908.76 ",93% of total billed charges for outpatient setting,$148.17 ,101% Medicaid OPPS fee schedule for outpatient setting,$148.17 ,101% Medicaid OPPS fee schedule for outpatient setting,"$5,400.48 ",85% of total billed charges for outpatient setting,"$5,718.15 ",90% of total billed charges for outpatient setting,"$5,718.15 ",90% of total billed charges for outpatient setting,$146.70 ,100% Medicaid OPPS fee schedule for outpatient setting,"$5,527.55 ",87% of total billed charges for outpatient setting,$146.70 ,100% Medicaid OPPS fee schedule for outpatient setting,$835.54 ,pay at 100% of APC for outpatient setting,"$4,447.45 ",70% of total billed charges for outpatient setting,$146.70 ,"$5,908.76 ","$5,082.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,95811,Sleep Lab with CPAP,920,"$7,100.50 ",$97.68 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,046.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,307.88 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$4,970.35 ",70% of total billed charges for outpatient setting,"$6,390.45 ",90% of total billed charges for outpatient setting,"$6,603.47 ",93% of total billed charges for outpatient setting,$98.66 ,101% Medicaid OPPS fee schedule for outpatient setting,$98.66 ,101% Medicaid OPPS fee schedule for outpatient setting,"$6,035.43 ",85% of total billed charges for outpatient setting,"$6,390.45 ",90% of total billed charges for outpatient setting,"$6,390.45 ",90% of total billed charges for outpatient setting,$97.68 ,100% Medicaid OPPS fee schedule for outpatient setting,"$6,177.44 ",87% of total billed charges for outpatient setting,$97.68 ,100% Medicaid OPPS fee schedule for outpatient setting,$835.54 ,pay at 100% of APC for outpatient setting,"$4,970.35 ",70% of total billed charges for outpatient setting,$97.68 ,"$6,603.47 ","$5,680.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94150,Spirometry / Vital Capacity,410,$250.50 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$34.01 ,100% of BCBS Fee schedule for outpatient setting,$50.25 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$175.35 ,70% of total billed charges for outpatient setting,$225.45 ,90% of total billed charges for outpatient setting,$232.97 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$212.93 ,85% of total billed charges for outpatient setting,$225.45 ,90% of total billed charges for outpatient setting,$225.45 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$217.94 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$130.04 ,pay at 100% of APC for outpatient setting,$175.35 ,70% of total billed charges for outpatient setting,$6.87 ,$232.97 ,$200.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,94060,Spirometry Pre/Post,460,$657.50 ,$31.40 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$189.08 ,100% of BCBS Fee schedule for outpatient setting,$80.34 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$460.25 ,70% of total billed charges for outpatient setting,$591.75 ,90% of total billed charges for outpatient setting,$611.48 ,93% of total billed charges for outpatient setting,$31.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$558.88 ,85% of total billed charges for outpatient setting,$591.75 ,90% of total billed charges for outpatient setting,$591.75 ,90% of total billed charges for outpatient setting,$31.40 ,100% Medicaid OPPS fee schedule for outpatient setting,$572.03 ,87% of total billed charges for outpatient setting,$31.40 ,100% Medicaid OPPS fee schedule for outpatient setting,$250.43 ,pay at 100% of APC for outpatient setting,$460.25 ,70% of total billed charges for outpatient setting,$31.40 ,$611.48 ,$526.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93017,Treadmill - cardiac imaging,482,"$5,355.50 ",$48.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$352.84 ,100% of BCBS Fee schedule for outpatient setting,$71.19 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$3,748.85 ",70% of total billed charges for outpatient setting,"$4,819.95 ",90% of total billed charges for outpatient setting,"$4,980.62 ",93% of total billed charges for outpatient setting,$48.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$48.56 ,101% Medicaid OPPS fee schedule for outpatient setting,"$4,552.18 ",85% of total billed charges for outpatient setting,"$4,819.95 ",90% of total billed charges for outpatient setting,"$4,819.95 ",90% of total billed charges for outpatient setting,$48.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,659.29 ",87% of total billed charges for outpatient setting,$48.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$250.43 ,pay at 100% of APC for outpatient setting,"$3,748.85 ",70% of total billed charges for outpatient setting,$48.08 ,"$4,980.62 ","$4,284.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93017,Treadmill - regular,482,"$1,153.50 ",$48.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$352.84 ,100% of BCBS Fee schedule for outpatient setting,$71.19 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$807.45 ,70% of total billed charges for outpatient setting,"$1,038.15 ",90% of total billed charges for outpatient setting,"$1,072.76 ",93% of total billed charges for outpatient setting,$48.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$48.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$980.48 ,85% of total billed charges for outpatient setting,"$1,038.15 ",90% of total billed charges for outpatient setting,"$1,038.15 ",90% of total billed charges for outpatient setting,$48.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,003.55 ",87% of total billed charges for outpatient setting,$48.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$250.43 ,pay at 100% of APC for outpatient setting,$807.45 ,70% of total billed charges for outpatient setting,$48.08 ,"$1,072.76 ",$922.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Cardio Pulmonary,93971,Ultrasound Venous Extremity,921,"$1,131.50 ",$120.67 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$476.00 ,100% of BCBS Fee schedule for outpatient setting,$249.26 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$792.05 ,70% of total billed charges for outpatient setting,"$1,018.35 ",90% of total billed charges for outpatient setting,"$1,052.30 ",93% of total billed charges for outpatient setting,$121.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$121.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$961.78 ,85% of total billed charges for outpatient setting,"$1,018.35 ",90% of total billed charges for outpatient setting,"$1,018.35 ",90% of total billed charges for outpatient setting,$120.67 ,100% Medicaid OPPS fee schedule for outpatient setting,$984.41 ,87% of total billed charges for outpatient setting,$120.67 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$792.05 ,70% of total billed charges for outpatient setting,$95.57 ,"$1,052.30 ",$905.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99281,Emergency Room Eval & Management Level 1,450,$407.00 ,$57.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$168.62 ,100% of BCBS Fee schedule for outpatient setting,$45.87 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$284.90 ,70% of total billed charges for outpatient setting,$366.30 ,90% of total billed charges for outpatient setting,$378.51 ,93% of total billed charges for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,$345.95 ,85% of total billed charges for outpatient setting,$366.30 ,90% of total billed charges for outpatient setting,$366.30 ,90% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$354.09 ,87% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$67.14 ,pay at 100% of APC for outpatient setting,$284.90 ,70% of total billed charges for outpatient setting,$45.87 ,$378.51 ,$325.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99282,Emergency Room Eval & Management Level 2,450,$556.50 ,$57.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$262.68 ,100% of BCBS Fee schedule for outpatient setting,$88.79 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$389.55 ,70% of total billed charges for outpatient setting,$500.85 ,90% of total billed charges for outpatient setting,$517.55 ,93% of total billed charges for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,$473.03 ,85% of total billed charges for outpatient setting,$500.85 ,90% of total billed charges for outpatient setting,$500.85 ,90% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$484.16 ,87% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$124.91 ,pay at 100% of APC for outpatient setting,$389.55 ,70% of total billed charges for outpatient setting,$57.18 ,$517.55 ,$445.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99283,Emergency Room Eval & Management Level 3,450,$921.50 ,$57.44 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$403.75 ,100% of BCBS Fee schedule for outpatient setting,$150.90 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$645.05 ,70% of total billed charges for outpatient setting,$829.35 ,90% of total billed charges for outpatient setting,$857.00 ,93% of total billed charges for outpatient setting,$58.01 ,101% Medicaid OPPS fee schedule for outpatient setting,$58.01 ,101% Medicaid OPPS fee schedule for outpatient setting,$783.28 ,85% of total billed charges for outpatient setting,$829.35 ,90% of total billed charges for outpatient setting,$829.35 ,90% of total billed charges for outpatient setting,$57.44 ,100% Medicaid OPPS fee schedule for outpatient setting,$801.71 ,87% of total billed charges for outpatient setting,$57.44 ,100% Medicaid OPPS fee schedule for outpatient setting,$219.11 ,pay at 100% of APC for outpatient setting,$645.05 ,70% of total billed charges for outpatient setting,$57.44 ,$857.00 ,$737.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99284,Emergency Room Eval & Management Level 4,450,"$1,312.50 ",$57.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$688.36 ,100% of BCBS Fee schedule for outpatient setting,$255.68 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$918.75 ,70% of total billed charges for outpatient setting,"$1,181.25 ",90% of total billed charges for outpatient setting,"$1,220.63 ",93% of total billed charges for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,$57.75 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,115.63 ",85% of total billed charges for outpatient setting,"$1,181.25 ",90% of total billed charges for outpatient setting,"$1,181.25 ",90% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,141.88 ",87% of total billed charges for outpatient setting,$57.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$341.24 ,pay at 100% of APC for outpatient setting,$918.75 ,70% of total billed charges for outpatient setting,$57.18 ,"$1,220.63 ","$1,050.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99285,Emergency Room Eval & Management Level 5,450,"$2,366.00 ",$138.76 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,069.84 ",100% of BCBS Fee schedule for outpatient setting,$371.01 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,656.20 ",70% of total billed charges for outpatient setting,"$2,129.40 ",90% of total billed charges for outpatient setting,"$2,200.38 ",93% of total billed charges for outpatient setting,$140.15 ,101% Medicaid OPPS fee schedule for outpatient setting,$140.15 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,011.10 ",85% of total billed charges for outpatient setting,"$2,129.40 ",90% of total billed charges for outpatient setting,"$2,129.40 ",90% of total billed charges for outpatient setting,$138.76 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,058.42 ",87% of total billed charges for outpatient setting,$138.76 ,100% Medicaid OPPS fee schedule for outpatient setting,$490.13 ,pay at 100% of APC for outpatient setting,"$1,656.20 ",70% of total billed charges for outpatient setting,$138.76 ,"$2,200.38 ","$1,892.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99291,Emergency Room Critical Care 1st Hour,450,"$3,297.00 ",$153.82 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,011.67 ",100% of BCBS Fee schedule for outpatient setting,$455.05 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,307.90 ",70% of total billed charges for outpatient setting,"$2,967.30 ",90% of total billed charges for outpatient setting,"$3,066.21 ",93% of total billed charges for outpatient setting,$155.36 ,101% Medicaid OPPS fee schedule for outpatient setting,$155.36 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,802.45 ",85% of total billed charges for outpatient setting,"$2,967.30 ",90% of total billed charges for outpatient setting,"$2,967.30 ",90% of total billed charges for outpatient setting,$153.82 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,868.39 ",87% of total billed charges for outpatient setting,$153.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$686.51 ,pay at 100% of APC for outpatient setting,"$2,307.90 ",70% of total billed charges for outpatient setting,$153.82 ,"$3,066.21 ","$2,637.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,99292,Emergency Room Critical Care Each Additional 30 min,450,$745.00 ,$74.05 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$300.29 ,100% of BCBS Fee schedule for outpatient setting,$228.38 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$521.50 ,70% of total billed charges for outpatient setting,$670.50 ,90% of total billed charges for outpatient setting,$692.85 ,93% of total billed charges for outpatient setting,$74.79 ,101% Medicaid OPPS fee schedule for outpatient setting,$74.79 ,101% Medicaid OPPS fee schedule for outpatient setting,$633.25 ,85% of total billed charges for outpatient setting,$670.50 ,90% of total billed charges for outpatient setting,$670.50 ,90% of total billed charges for outpatient setting,$74.05 ,100% Medicaid OPPS fee schedule for outpatient setting,$648.15 ,87% of total billed charges for outpatient setting,$74.05 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$521.50 ,70% of total billed charges for outpatient setting,$74.05 ,$692.85 ,$596.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96372,Injection Antibiotic or other medication,450,$191.50 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$29.88 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$134.05 ,70% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$178.10 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$162.78 ,85% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$166.61 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$60.33 ,pay at 100% of APC for outpatient setting,$134.05 ,70% of total billed charges for outpatient setting,$21.17 ,$178.10 ,$153.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,90471,Injection vaccine,450,$171.00 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.00 ,100% of BCBS Fee schedule for outpatient setting,$34.72 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$119.70 ,70% of total billed charges for outpatient setting,$153.90 ,90% of total billed charges for outpatient setting,$159.03 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$145.35 ,85% of total billed charges for outpatient setting,$153.90 ,90% of total billed charges for outpatient setting,$153.90 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$148.77 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$60.33 ,pay at 100% of APC for outpatient setting,$119.70 ,70% of total billed charges for outpatient setting,$8.00 ,$159.03 ,$136.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96360,IV Hydration 1st hour,450,$460.50 ,$62.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$70.31 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$428.27 ,93% of total billed charges for outpatient setting,$63.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$63.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$391.43 ,85% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$62.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$400.64 ,87% of total billed charges for outpatient setting,$62.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$62.66 ,$428.27 ,$368.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96361,IV Hydration each additional hour,450,$185.00 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$26.55 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$21.17 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96365,IV Therapy 1st hour,450,$460.50 ,$109.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$138.36 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$428.27 ,93% of total billed charges for outpatient setting,$110.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$110.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$391.43 ,85% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$109.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$400.64 ,87% of total billed charges for outpatient setting,$109.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$109.37 ,$428.27 ,$368.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96366,IV Therapy each additional hour,450,$185.00 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$43.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$21.17 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96367,IV Therapy Sequential Drugs,450,$185.00 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$62.15 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$60.33 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$30.72 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96368,IV Therapy Simultaneous Drugs,450,$91.50 ,N/A,Not separately reimbursable per CMS guidelines,$1.00 ,Not separately reimbursable per CMS guidelines,$42.31 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$64.05 ,70% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,$85.10 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$77.78 ,85% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$79.61 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$64.05 ,70% of total billed charges for outpatient setting,$1.00 ,$85.10 ,$73.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96374,IV Push Medication,450,$245.00 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$80.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$171.50 ,70% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$227.85 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$208.25 ,85% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$213.15 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$171.50 ,70% of total billed charges for outpatient setting,$30.72 ,$227.85 ,$196.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96375,IV Push each additional Medication,450,$173.50 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$32.85 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$121.45 ,70% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$161.36 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$147.48 ,85% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$150.95 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$121.45 ,70% of total billed charges for outpatient setting,$30.72 ,$161.36 ,$138.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,96376,IV Push same drug >30 minutes,450,$188.50 ,$15.60 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$131.95 ,70% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$175.31 ,93% of total billed charges for outpatient setting,$15.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$160.23 ,85% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$15.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$164.00 ,87% of total billed charges for outpatient setting,$15.60 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$131.95 ,70% of total billed charges for outpatient setting,$15.60 ,$175.31 ,$150.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,51702,Insert Bladder Catheter Simple,450,$342.00 ,$31.19 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$67.00 ,100% of BCBS Fee schedule for outpatient setting,$52.93 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$239.40 ,70% of total billed charges for outpatient setting,$307.80 ,90% of total billed charges for outpatient setting,$318.06 ,93% of total billed charges for outpatient setting,$31.50 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.50 ,101% Medicaid OPPS fee schedule for outpatient setting,$290.70 ,85% of total billed charges for outpatient setting,$256.50 ,90% of total billed charges for outpatient setting,$307.80 ,90% of total billed charges for outpatient setting,$31.19 ,100% Medicaid OPPS fee schedule for outpatient setting,$297.54 ,87% of total billed charges for outpatient setting,$31.19 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.82 ,pay at 100% of APC for outpatient setting,$239.40 ,70% of total billed charges for outpatient setting,$31.19 ,$318.06 ,$273.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,30901,Nasal Hemorrhage Simple,450,$376.00 ,$294.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$484.00 ,100% of BCBS Fee schedule for outpatient setting,$116.62 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$263.20 ,70% of total billed charges for outpatient setting,$338.40 ,90% of total billed charges for outpatient setting,$349.68 ,93% of total billed charges for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$319.60 ,85% of total billed charges for outpatient setting,$282.00 ,90% of total billed charges for outpatient setting,$338.40 ,90% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$327.12 ,87% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.82 ,pay at 100% of APC for outpatient setting,$263.20 ,70% of total billed charges for outpatient setting,$103.82 ,$484.00 ,$300.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,12001,Simple Repair Trunk/Extremity < 2.6CM,450,$553.50 ,$261.01 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$379.00 ,100% of BCBS Fee schedule for outpatient setting,$91.98 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$387.45 ,70% of total billed charges for outpatient setting,$498.15 ,90% of total billed charges for outpatient setting,$514.76 ,93% of total billed charges for outpatient setting,$263.62 ,101% Medicaid OPPS fee schedule for outpatient setting,$263.62 ,101% Medicaid OPPS fee schedule for outpatient setting,$470.48 ,85% of total billed charges for outpatient setting,$415.13 ,90% of total billed charges for outpatient setting,$498.15 ,90% of total billed charges for outpatient setting,$261.01 ,100% Medicaid OPPS fee schedule for outpatient setting,$481.55 ,87% of total billed charges for outpatient setting,$261.01 ,100% Medicaid OPPS fee schedule for outpatient setting,$161.47 ,pay at 100% of APC for outpatient setting,$387.45 ,70% of total billed charges for outpatient setting,$91.98 ,$514.76 ,$442.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Emergency Room,12002,Simple Repair Trunk/Extremity 2.6-7.5CM,450,$808.50 ,$327.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$120.71 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$565.95 ,70% of total billed charges for outpatient setting,$727.65 ,90% of total billed charges for outpatient setting,$751.91 ,93% of total billed charges for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,$687.23 ,85% of total billed charges for outpatient setting,$606.38 ,90% of total billed charges for outpatient setting,$727.65 ,90% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$703.40 ,87% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$161.47 ,pay at 100% of APC for outpatient setting,$565.95 ,70% of total billed charges for outpatient setting,$120.71 ,$751.91 ,$646.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82803,ABG,301,$557.00 ,$27.79 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$67.38 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$389.90 ,70% of total billed charges for outpatient setting,$501.30 ,90% of total billed charges for outpatient setting,$518.01 ,93% of total billed charges for outpatient setting,$28.07 ,101% Medicaid OPPS fee schedule for outpatient setting,$28.07 ,101% Medicaid OPPS fee schedule for outpatient setting,$473.45 ,85% of total billed charges for outpatient setting,$501.30 ,90% of total billed charges for outpatient setting,$501.30 ,90% of total billed charges for outpatient setting,$27.79 ,100% Medicaid OPPS fee schedule for outpatient setting,$484.59 ,87% of total billed charges for outpatient setting,$27.79 ,100% Medicaid OPPS fee schedule for outpatient setting,$26.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$389.90 ,70% of total billed charges for outpatient setting,$26.07 ,$518.01 ,$445.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86900,ABO - Blood Group Typing,300,$99.00 ,$5.38 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$16.38 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$69.30 ,70% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$92.07 ,93% of total billed charges for outpatient setting,$5.43 ,101% Medicaid OPPS fee schedule for outpatient setting,$5.43 ,101% Medicaid OPPS fee schedule for outpatient setting,$84.15 ,85% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$5.38 ,100% Medicaid OPPS fee schedule for outpatient setting,$86.13 ,87% of total billed charges for outpatient setting,$5.38 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.82 ,pay at 100% of APC for outpatient setting,$69.30 ,70% of total billed charges for outpatient setting,$5.38 ,$103.82 ,$79.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80329,Acetaminophen,301,$154.50 ,$28.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$57.29 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$108.15 ,70% of total billed charges for outpatient setting,$139.05 ,90% of total billed charges for outpatient setting,$143.69 ,93% of total billed charges for outpatient setting,$28.95 ,101% Medicaid OPPS fee schedule for outpatient setting,$28.95 ,101% Medicaid OPPS fee schedule for outpatient setting,$131.33 ,85% of total billed charges for outpatient setting,$139.05 ,90% of total billed charges for outpatient setting,$139.05 ,90% of total billed charges for outpatient setting,$28.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$134.42 ,87% of total billed charges for outpatient setting,$28.66 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,100% CMS Medicare physician fee schedule for outpatient setting,$108.15 ,70% of total billed charges for outpatient setting,$28.66 ,$143.69 ,$123.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82040,Albumin Serum,301,$87.50 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$10.52 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$61.25 ,70% of total billed charges for outpatient setting,$78.75 ,90% of total billed charges for outpatient setting,$81.38 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$74.38 ,85% of total billed charges for outpatient setting,$78.75 ,90% of total billed charges for outpatient setting,$78.75 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$76.13 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.25 ,70% of total billed charges for outpatient setting,$4.95 ,$81.38 ,$70.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86003,Allergen Specific IGE,302,$33.50 ,$8.04 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$15.36 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$23.45 ,70% of total billed charges for outpatient setting,$30.15 ,90% of total billed charges for outpatient setting,$31.16 ,93% of total billed charges for outpatient setting,$8.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$28.48 ,85% of total billed charges for outpatient setting,$30.15 ,90% of total billed charges for outpatient setting,$30.15 ,90% of total billed charges for outpatient setting,$8.04 ,100% Medicaid OPPS fee schedule for outpatient setting,$29.15 ,87% of total billed charges for outpatient setting,$8.04 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.45 ,70% of total billed charges for outpatient setting,$5.22 ,$31.16 ,$26.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82140,Ammonia 24 Hr Urine,307,$242.50 ,$13.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$48.89 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$169.75 ,70% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$225.53 ,93% of total billed charges for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$206.13 ,85% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$210.98 ,87% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$169.75 ,70% of total billed charges for outpatient setting,$13.74 ,$225.53 ,$194.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82150,Amylase Urine,301,$165.50 ,$9.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$24.80 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$115.85 ,70% of total billed charges for outpatient setting,$148.95 ,90% of total billed charges for outpatient setting,$153.92 ,93% of total billed charges for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$140.68 ,85% of total billed charges for outpatient setting,$148.95 ,90% of total billed charges for outpatient setting,$148.95 ,90% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$143.99 ,87% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$115.85 ,70% of total billed charges for outpatient setting,$6.48 ,$153.92 ,$132.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86039,ANA Titer Measure Antibody for Autoimmune,302,$102.50 ,$20.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$41.36 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$71.75 ,70% of total billed charges for outpatient setting,$92.25 ,90% of total billed charges for outpatient setting,$95.33 ,93% of total billed charges for outpatient setting,$20.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$20.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$87.13 ,85% of total billed charges for outpatient setting,$92.25 ,90% of total billed charges for outpatient setting,$92.25 ,90% of total billed charges for outpatient setting,$20.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$89.18 ,87% of total billed charges for outpatient setting,$20.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.75 ,70% of total billed charges for outpatient setting,$11.16 ,$95.33 ,$82.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86038,Anti-nuclearAntibodies (ANA) Screen for Autoimmune,302,$311.50 ,$21.85 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.86 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$218.05 ,70% of total billed charges for outpatient setting,$280.35 ,90% of total billed charges for outpatient setting,$289.70 ,93% of total billed charges for outpatient setting,$22.07 ,101% Medicaid OPPS fee schedule for outpatient setting,$22.07 ,101% Medicaid OPPS fee schedule for outpatient setting,$264.78 ,85% of total billed charges for outpatient setting,$280.35 ,90% of total billed charges for outpatient setting,$280.35 ,90% of total billed charges for outpatient setting,$21.85 ,100% Medicaid OPPS fee schedule for outpatient setting,$271.01 ,87% of total billed charges for outpatient setting,$21.85 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$218.05 ,70% of total billed charges for outpatient setting,$12.09 ,$289.70 ,$249.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,36600,Arterial Puncture / Blood Draw,300,$90.50 ,$13.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$67.00 ,100% of BCBS Fee schedule for outpatient setting,$32.67 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$63.35 ,70% of total billed charges for outpatient setting,$81.45 ,90% of total billed charges for outpatient setting,$84.17 ,93% of total billed charges for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$76.93 ,85% of total billed charges for outpatient setting,$67.88 ,90% of total billed charges for outpatient setting,$81.45 ,90% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$78.74 ,87% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.82 ,pay at 100% of APC for outpatient setting,$63.35 ,70% of total billed charges for outpatient setting,$13.74 ,$103.82 ,$72.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87071,Bacterial Isolation & ID Any Source,306,$188.00 ,$7.25 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$31.32 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$131.60 ,70% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$174.84 ,93% of total billed charges for outpatient setting,$7.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$7.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$159.80 ,85% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$7.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$163.56 ,87% of total billed charges for outpatient setting,$7.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$131.60 ,70% of total billed charges for outpatient setting,$7.25 ,$174.84 ,$150.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87040,Bacterial Isolation & ID Blood,306,$265.50 ,$12.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$38.03 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$185.85 ,70% of total billed charges for outpatient setting,$238.95 ,90% of total billed charges for outpatient setting,$246.92 ,93% of total billed charges for outpatient setting,$12.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$12.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$225.68 ,85% of total billed charges for outpatient setting,$238.95 ,90% of total billed charges for outpatient setting,$238.95 ,90% of total billed charges for outpatient setting,$12.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$230.99 ,87% of total billed charges for outpatient setting,$12.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.85 ,70% of total billed charges for outpatient setting,$10.32 ,$246.92 ,$212.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87088,Bacterial Isolation & ID Urine,306,$188.00 ,$13.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$25.94 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$131.60 ,70% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$174.84 ,93% of total billed charges for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$159.80 ,85% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$169.20 ,90% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$163.56 ,87% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$131.60 ,70% of total billed charges for outpatient setting,$8.09 ,$174.84 ,$150.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80048,Basic Metabolic Profile,301,$159.50 ,$13.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$19.46 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$111.65 ,70% of total billed charges for outpatient setting,$143.55 ,90% of total billed charges for outpatient setting,$148.34 ,93% of total billed charges for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$135.58 ,85% of total billed charges for outpatient setting,$143.55 ,90% of total billed charges for outpatient setting,$143.55 ,90% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$138.77 ,87% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$111.65 ,70% of total billed charges for outpatient setting,$8.46 ,$148.34 ,$127.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84702,Beta HCG Quantitative,301,$137.50 ,$11.77 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$59.76 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$96.25 ,70% of total billed charges for outpatient setting,$123.75 ,90% of total billed charges for outpatient setting,$127.88 ,93% of total billed charges for outpatient setting,$11.89 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.89 ,101% Medicaid OPPS fee schedule for outpatient setting,$116.88 ,85% of total billed charges for outpatient setting,$123.75 ,90% of total billed charges for outpatient setting,$123.75 ,90% of total billed charges for outpatient setting,$11.77 ,100% Medicaid OPPS fee schedule for outpatient setting,$119.63 ,87% of total billed charges for outpatient setting,$11.77 ,100% Medicaid OPPS fee schedule for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$96.25 ,70% of total billed charges for outpatient setting,$11.77 ,$127.88 ,$110.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82248,Bilirubin Direct,301,$92.50 ,$4.13 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$19.98 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$64.75 ,70% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$86.03 ,93% of total billed charges for outpatient setting,$4.17 ,101% Medicaid OPPS fee schedule for outpatient setting,$4.17 ,101% Medicaid OPPS fee schedule for outpatient setting,$78.63 ,85% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$4.13 ,100% Medicaid OPPS fee schedule for outpatient setting,$80.48 ,87% of total billed charges for outpatient setting,$4.13 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.75 ,70% of total billed charges for outpatient setting,$4.13 ,$86.03 ,$74.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80321,Blood Alcohol,301,$194.50 ,$19.50 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$45.93 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$136.15 ,70% of total billed charges for outpatient setting,$175.05 ,90% of total billed charges for outpatient setting,$180.89 ,93% of total billed charges for outpatient setting,$19.70 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.70 ,101% Medicaid OPPS fee schedule for outpatient setting,$165.33 ,85% of total billed charges for outpatient setting,$175.05 ,90% of total billed charges for outpatient setting,$175.05 ,90% of total billed charges for outpatient setting,$19.50 ,100% Medicaid OPPS fee schedule for outpatient setting,$169.22 ,87% of total billed charges for outpatient setting,$19.50 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,100% CMS Medicare physician fee schedule for outpatient setting,$136.15 ,70% of total billed charges for outpatient setting,$19.50 ,$180.89 ,$155.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83880,BNP,301,$268.50 ,$30.22 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$72.12 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$187.95 ,70% of total billed charges for outpatient setting,$241.65 ,90% of total billed charges for outpatient setting,$249.71 ,93% of total billed charges for outpatient setting,$30.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$30.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$228.23 ,85% of total billed charges for outpatient setting,$241.65 ,90% of total billed charges for outpatient setting,$241.65 ,90% of total billed charges for outpatient setting,$30.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$233.60 ,87% of total billed charges for outpatient setting,$30.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.95 ,70% of total billed charges for outpatient setting,$30.22 ,$249.71 ,$214.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,89051,Body Fluid Count & Differential,300,$118.00 ,$4.82 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$41.04 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$82.60 ,70% of total billed charges for outpatient setting,$106.20 ,90% of total billed charges for outpatient setting,$109.74 ,93% of total billed charges for outpatient setting,$4.87 ,101% Medicaid OPPS fee schedule for outpatient setting,$4.87 ,101% Medicaid OPPS fee schedule for outpatient setting,$100.30 ,85% of total billed charges for outpatient setting,$106.20 ,90% of total billed charges for outpatient setting,$106.20 ,90% of total billed charges for outpatient setting,$4.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$102.66 ,87% of total billed charges for outpatient setting,$4.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.60 ,70% of total billed charges for outpatient setting,$4.82 ,$109.74 ,$94.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84520,BUN,301,$83.00 ,$7.15 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.39 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$58.10 ,70% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$77.19 ,93% of total billed charges for outpatient setting,$7.22 ,101% Medicaid OPPS fee schedule for outpatient setting,$7.22 ,101% Medicaid OPPS fee schedule for outpatient setting,$70.55 ,85% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$7.15 ,100% Medicaid OPPS fee schedule for outpatient setting,$72.21 ,87% of total billed charges for outpatient setting,$7.15 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.10 ,70% of total billed charges for outpatient setting,$3.95 ,$77.19 ,$66.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87493,C Difficile Toxin Amp Probe,306,$360.00 ,$44.82 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$74.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$252.00 ,70% of total billed charges for outpatient setting,$324.00 ,90% of total billed charges for outpatient setting,$334.80 ,93% of total billed charges for outpatient setting,$45.27 ,101% Medicaid OPPS fee schedule for outpatient setting,$45.27 ,101% Medicaid OPPS fee schedule for outpatient setting,$306.00 ,85% of total billed charges for outpatient setting,$324.00 ,90% of total billed charges for outpatient setting,$324.00 ,90% of total billed charges for outpatient setting,$44.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$313.20 ,87% of total billed charges for outpatient setting,$44.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.00 ,70% of total billed charges for outpatient setting,$37.27 ,$334.80 ,$288.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87324,C Difficile Toxin Blood,306,$338.00 ,$13.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$54.30 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$236.60 ,70% of total billed charges for outpatient setting,$304.20 ,90% of total billed charges for outpatient setting,$314.34 ,93% of total billed charges for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$287.30 ,85% of total billed charges for outpatient setting,$304.20 ,90% of total billed charges for outpatient setting,$304.20 ,90% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$294.06 ,87% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$11.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$236.60 ,70% of total billed charges for outpatient setting,$11.98 ,$314.34 ,$270.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82310,Calcium,301,$92.50 ,$8.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$10.95 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$64.75 ,70% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$86.03 ,93% of total billed charges for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$78.63 ,85% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$83.25 ,90% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$80.48 ,87% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.75 ,70% of total billed charges for outpatient setting,$5.16 ,$86.03 ,$74.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87481,Candida Species (Yeast),306,$133.50 ,$13.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$60.80 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$93.45 ,70% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$124.16 ,93% of total billed charges for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$113.48 ,85% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$116.15 ,87% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.45 ,70% of total billed charges for outpatient setting,$13.08 ,$124.16 ,$106.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82365,Carbon Monoxide,301,$116.50 ,$16.48 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$49.86 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$81.55 ,70% of total billed charges for outpatient setting,$104.85 ,90% of total billed charges for outpatient setting,$108.35 ,93% of total billed charges for outpatient setting,$16.64 ,101% Medicaid OPPS fee schedule for outpatient setting,$16.64 ,101% Medicaid OPPS fee schedule for outpatient setting,$99.03 ,85% of total billed charges for outpatient setting,$104.85 ,90% of total billed charges for outpatient setting,$104.85 ,90% of total billed charges for outpatient setting,$16.48 ,100% Medicaid OPPS fee schedule for outpatient setting,$101.36 ,87% of total billed charges for outpatient setting,$16.48 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.55 ,70% of total billed charges for outpatient setting,$12.90 ,$108.35 ,$93.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85027,CBC w/Manual Differential,305,$143.50 ,$11.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$13.76 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$100.45 ,70% of total billed charges for outpatient setting,$129.15 ,90% of total billed charges for outpatient setting,$133.46 ,93% of total billed charges for outpatient setting,$11.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$121.98 ,85% of total billed charges for outpatient setting,$129.15 ,90% of total billed charges for outpatient setting,$129.15 ,90% of total billed charges for outpatient setting,$11.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$124.85 ,87% of total billed charges for outpatient setting,$11.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$100.45 ,70% of total billed charges for outpatient setting,$6.47 ,$133.46 ,$114.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85025,CBS w/Auto Differential,305,$191.00 ,$6.54 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$13.23 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$133.70 ,70% of total billed charges for outpatient setting,$171.90 ,90% of total billed charges for outpatient setting,$177.63 ,93% of total billed charges for outpatient setting,$6.61 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.61 ,101% Medicaid OPPS fee schedule for outpatient setting,$162.35 ,85% of total billed charges for outpatient setting,$171.90 ,90% of total billed charges for outpatient setting,$171.90 ,90% of total billed charges for outpatient setting,$6.54 ,100% Medicaid OPPS fee schedule for outpatient setting,$166.17 ,87% of total billed charges for outpatient setting,$6.54 ,100% Medicaid OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.70 ,70% of total billed charges for outpatient setting,$6.54 ,$177.63 ,$152.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82378,CEA,301,$337.00 ,$34.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$70.14 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$235.90 ,70% of total billed charges for outpatient setting,$303.30 ,90% of total billed charges for outpatient setting,$313.41 ,93% of total billed charges for outpatient setting,$34.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$34.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$286.45 ,85% of total billed charges for outpatient setting,$303.30 ,90% of total billed charges for outpatient setting,$303.30 ,90% of total billed charges for outpatient setting,$34.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$293.19 ,87% of total billed charges for outpatient setting,$34.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$18.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$235.90 ,70% of total billed charges for outpatient setting,$18.96 ,$313.41 ,$269.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87491,Chlamydia Trachomatis Amp Probe,306,$162.50 ,$53.93 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$74.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$113.75 ,70% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$151.13 ,93% of total billed charges for outpatient setting,$54.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$54.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$138.13 ,85% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$53.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$141.38 ,87% of total billed charges for outpatient setting,$53.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.75 ,70% of total billed charges for outpatient setting,$35.09 ,$151.13 ,$130.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83718,Cholesterol HDL,301,$148.50 ,$14.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$17.40 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$103.95 ,70% of total billed charges for outpatient setting,$133.65 ,90% of total billed charges for outpatient setting,$138.11 ,93% of total billed charges for outpatient setting,$14.87 ,101% Medicaid OPPS fee schedule for outpatient setting,$14.87 ,101% Medicaid OPPS fee schedule for outpatient setting,$126.23 ,85% of total billed charges for outpatient setting,$133.65 ,90% of total billed charges for outpatient setting,$133.65 ,90% of total billed charges for outpatient setting,$14.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$129.20 ,87% of total billed charges for outpatient setting,$14.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$103.95 ,70% of total billed charges for outpatient setting,$8.19 ,$138.11 ,$118.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82553,CKMB,301,$233.50 ,$20.03 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$53.49 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$163.45 ,70% of total billed charges for outpatient setting,$210.15 ,90% of total billed charges for outpatient setting,$217.16 ,93% of total billed charges for outpatient setting,$20.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$20.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$198.48 ,85% of total billed charges for outpatient setting,$210.15 ,90% of total billed charges for outpatient setting,$210.15 ,90% of total billed charges for outpatient setting,$20.03 ,100% Medicaid OPPS fee schedule for outpatient setting,$203.15 ,87% of total billed charges for outpatient setting,$20.03 ,100% Medicaid OPPS fee schedule for outpatient setting,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$163.45 ,70% of total billed charges for outpatient setting,$11.55 ,$217.16 ,$186.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80053,Comprehensive Metabolic Panel,301,$226.00 ,$16.33 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$22.46 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$158.20 ,70% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$210.18 ,93% of total billed charges for outpatient setting,$16.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$16.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$192.10 ,85% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$16.33 ,100% Medicaid OPPS fee schedule for outpatient setting,$196.62 ,87% of total billed charges for outpatient setting,$16.33 ,100% Medicaid OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.20 ,70% of total billed charges for outpatient setting,$10.56 ,$210.18 ,$180.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86850,Coombs Antibody Screen,302,$112.50 ,$9.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$21.20 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$78.75 ,70% of total billed charges for outpatient setting,$101.25 ,90% of total billed charges for outpatient setting,$104.63 ,93% of total billed charges for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$95.63 ,85% of total billed charges for outpatient setting,$101.25 ,90% of total billed charges for outpatient setting,$101.25 ,90% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$97.88 ,87% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$44.83 ,pay at 100% of APC for outpatient setting,$78.75 ,70% of total billed charges for outpatient setting,$9.81 ,$104.63 ,$90.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82550,CPK,301,$121.00 ,$11.32 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$22.88 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$84.70 ,70% of total billed charges for outpatient setting,$108.90 ,90% of total billed charges for outpatient setting,$112.53 ,93% of total billed charges for outpatient setting,$11.43 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.43 ,101% Medicaid OPPS fee schedule for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$108.90 ,90% of total billed charges for outpatient setting,$108.90 ,90% of total billed charges for outpatient setting,$11.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$105.27 ,87% of total billed charges for outpatient setting,$11.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.70 ,70% of total billed charges for outpatient setting,$6.51 ,$112.53 ,$96.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86140,C-Reactive Protein,302,$60.00 ,$8.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$25.88 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$42.00 ,70% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$55.80 ,93% of total billed charges for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$52.20 ,87% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.00 ,70% of total billed charges for outpatient setting,$5.18 ,$55.80 ,$48.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82565,Creatinime,301,$22.00 ,$9.25 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$10.89 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$15.40 ,70% of total billed charges for outpatient setting,$19.80 ,90% of total billed charges for outpatient setting,$20.46 ,93% of total billed charges for outpatient setting,$9.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$18.70 ,85% of total billed charges for outpatient setting,$19.80 ,90% of total billed charges for outpatient setting,$19.80 ,90% of total billed charges for outpatient setting,$9.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$19.14 ,87% of total billed charges for outpatient setting,$9.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.40 ,70% of total billed charges for outpatient setting,$5.12 ,$20.46 ,$17.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82570,Creatinine Urine,301,$97.50 ,$9.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$21.32 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$68.25 ,70% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$90.68 ,93% of total billed charges for outpatient setting,$9.16 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.16 ,101% Medicaid OPPS fee schedule for outpatient setting,$82.88 ,85% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$9.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$84.83 ,87% of total billed charges for outpatient setting,$9.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.25 ,70% of total billed charges for outpatient setting,$5.18 ,$90.68 ,$78.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87070,Culture Body Fluid,306,$226.00 ,$9.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$31.56 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$158.20 ,70% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$210.18 ,93% of total billed charges for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$192.10 ,85% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$196.62 ,87% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.20 ,70% of total billed charges for outpatient setting,$8.61 ,$210.18 ,$180.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87086,Culture Urine Quantitative,306,$200.00 ,$13.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$30.08 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$140.00 ,70% of total billed charges for outpatient setting,$180.00 ,90% of total billed charges for outpatient setting,$186.00 ,93% of total billed charges for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$170.00 ,85% of total billed charges for outpatient setting,$180.00 ,90% of total billed charges for outpatient setting,$180.00 ,90% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$174.00 ,87% of total billed charges for outpatient setting,$13.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.00 ,70% of total billed charges for outpatient setting,$8.07 ,$186.00 ,$160.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85379,D-Dimer DVT,305,$146.50 ,$13.35 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$72.89 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$102.55 ,70% of total billed charges for outpatient setting,$131.85 ,90% of total billed charges for outpatient setting,$136.25 ,93% of total billed charges for outpatient setting,$13.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$124.53 ,85% of total billed charges for outpatient setting,$131.85 ,90% of total billed charges for outpatient setting,$131.85 ,90% of total billed charges for outpatient setting,$13.35 ,100% Medicaid OPPS fee schedule for outpatient setting,$127.46 ,87% of total billed charges for outpatient setting,$13.35 ,100% Medicaid OPPS fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$102.55 ,70% of total billed charges for outpatient setting,$10.18 ,$136.25 ,$117.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80306,Drug Abuse Qualitative Urine,300,$312.00 ,$20.05 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$37.14 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$218.40 ,70% of total billed charges for outpatient setting,$280.80 ,90% of total billed charges for outpatient setting,$290.16 ,93% of total billed charges for outpatient setting,$20.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$20.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$265.20 ,85% of total billed charges for outpatient setting,$280.80 ,90% of total billed charges for outpatient setting,$280.80 ,90% of total billed charges for outpatient setting,$20.05 ,100% Medicaid OPPS fee schedule for outpatient setting,$271.44 ,87% of total billed charges for outpatient setting,$20.05 ,100% Medicaid OPPS fee schedule for outpatient setting,$17.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$218.40 ,70% of total billed charges for outpatient setting,$17.14 ,$290.16 ,$249.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,89055,Fecal Leukocytes Stool WBC,301,$31.00 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$14.91 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$21.70 ,70% of total billed charges for outpatient setting,$27.90 ,90% of total billed charges for outpatient setting,$28.83 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$26.35 ,85% of total billed charges for outpatient setting,$27.90 ,90% of total billed charges for outpatient setting,$27.90 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$26.97 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.70 ,70% of total billed charges for outpatient setting,$4.26 ,$28.83 ,$24.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82728,Ferritin,301,$103.50 ,$24.63 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$52.70 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$72.45 ,70% of total billed charges for outpatient setting,$93.15 ,90% of total billed charges for outpatient setting,$96.26 ,93% of total billed charges for outpatient setting,$24.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$24.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$87.98 ,85% of total billed charges for outpatient setting,$93.15 ,90% of total billed charges for outpatient setting,$93.15 ,90% of total billed charges for outpatient setting,$24.63 ,100% Medicaid OPPS fee schedule for outpatient setting,$90.05 ,87% of total billed charges for outpatient setting,$24.63 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.45 ,70% of total billed charges for outpatient setting,$13.63 ,$96.26 ,$82.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82746,Folate Serum,301,$120.00 ,$26.58 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$61.20 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$84.00 ,70% of total billed charges for outpatient setting,$108.00 ,90% of total billed charges for outpatient setting,$111.60 ,93% of total billed charges for outpatient setting,$26.85 ,101% Medicaid OPPS fee schedule for outpatient setting,$26.85 ,101% Medicaid OPPS fee schedule for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$108.00 ,90% of total billed charges for outpatient setting,$108.00 ,90% of total billed charges for outpatient setting,$26.58 ,100% Medicaid OPPS fee schedule for outpatient setting,$104.40 ,87% of total billed charges for outpatient setting,$26.58 ,100% Medicaid OPPS fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.00 ,70% of total billed charges for outpatient setting,$14.70 ,$111.60 ,$96.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82947,Glucose,301,$75.00 ,$6.03 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.55 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$52.50 ,70% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$69.75 ,93% of total billed charges for outpatient setting,$6.09 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.09 ,101% Medicaid OPPS fee schedule for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$6.03 ,100% Medicaid OPPS fee schedule for outpatient setting,$65.25 ,87% of total billed charges for outpatient setting,$6.03 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$3.93 ,$69.75 ,$60.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82948,Glucose BSM,301,$75.00 ,$2.06 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.33 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$52.50 ,70% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$69.75 ,93% of total billed charges for outpatient setting,$2.08 ,101% Medicaid OPPS fee schedule for outpatient setting,$2.08 ,101% Medicaid OPPS fee schedule for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$67.50 ,90% of total billed charges for outpatient setting,$2.06 ,100% Medicaid OPPS fee schedule for outpatient setting,$65.25 ,87% of total billed charges for outpatient setting,$2.06 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$2.06 ,$69.75 ,$60.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82951,Glucose Tolerance 3 specimens,301,$145.00 ,$23.29 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$48.24 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$101.50 ,70% of total billed charges for outpatient setting,$130.50 ,90% of total billed charges for outpatient setting,$134.85 ,93% of total billed charges for outpatient setting,$23.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$23.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$123.25 ,85% of total billed charges for outpatient setting,$130.50 ,90% of total billed charges for outpatient setting,$130.50 ,90% of total billed charges for outpatient setting,$23.29 ,100% Medicaid OPPS fee schedule for outpatient setting,$126.15 ,87% of total billed charges for outpatient setting,$23.29 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.50 ,70% of total billed charges for outpatient setting,$12.87 ,$134.85 ,$116.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82952,Glucose Tolerance each additional,301,$49.50 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$14.43 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$34.65 ,70% of total billed charges for outpatient setting,$44.55 ,90% of total billed charges for outpatient setting,$46.04 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$42.08 ,85% of total billed charges for outpatient setting,$44.55 ,90% of total billed charges for outpatient setting,$44.55 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$43.07 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.92 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.65 ,70% of total billed charges for outpatient setting,$3.92 ,$46.04 ,$39.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87338,H Pylori AG Stool,306,$180.00 ,$17.76 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$30.87 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$126.00 ,70% of total billed charges for outpatient setting,$162.00 ,90% of total billed charges for outpatient setting,$167.40 ,93% of total billed charges for outpatient setting,$17.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$153.00 ,85% of total billed charges for outpatient setting,$162.00 ,90% of total billed charges for outpatient setting,$162.00 ,90% of total billed charges for outpatient setting,$17.76 ,100% Medicaid OPPS fee schedule for outpatient setting,$156.60 ,87% of total billed charges for outpatient setting,$17.76 ,100% Medicaid OPPS fee schedule for outpatient setting,$14.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.00 ,70% of total billed charges for outpatient setting,$14.38 ,$167.40 ,$144.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86677,H Pylori Antibodies IG,302,$173.00 ,$9.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$39.36 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$121.10 ,70% of total billed charges for outpatient setting,$155.70 ,90% of total billed charges for outpatient setting,$160.89 ,93% of total billed charges for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$147.05 ,85% of total billed charges for outpatient setting,$155.70 ,90% of total billed charges for outpatient setting,$155.70 ,90% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$150.51 ,87% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$121.10 ,70% of total billed charges for outpatient setting,$9.81 ,$160.89 ,$138.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85014,Hematocrit,305,$45.00 ,$1.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.82 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$31.50 ,70% of total billed charges for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$41.85 ,93% of total billed charges for outpatient setting,$1.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$1.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$1.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$39.15 ,87% of total billed charges for outpatient setting,$1.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$1.71 ,$41.85 ,$36.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85018,Hemoglobin,305,$19.00 ,$1.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$9.65 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$13.30 ,70% of total billed charges for outpatient setting,$17.10 ,90% of total billed charges for outpatient setting,$17.67 ,93% of total billed charges for outpatient setting,$1.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$1.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$16.15 ,85% of total billed charges for outpatient setting,$17.10 ,90% of total billed charges for outpatient setting,$17.10 ,90% of total billed charges for outpatient setting,$1.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$16.53 ,87% of total billed charges for outpatient setting,$1.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.30 ,70% of total billed charges for outpatient setting,$1.71 ,$17.67 ,$15.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83036,Hemoglobin A1C,301,$70.50 ,$17.55 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$35.58 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$49.35 ,70% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$65.57 ,93% of total billed charges for outpatient setting,$17.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$59.93 ,85% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$17.55 ,100% Medicaid OPPS fee schedule for outpatient setting,$61.34 ,87% of total billed charges for outpatient setting,$17.55 ,100% Medicaid OPPS fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.35 ,70% of total billed charges for outpatient setting,$9.71 ,$65.57 ,$56.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80076,Hepatic Panel,301,$292.00 ,$14.14 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$31.56 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$204.40 ,70% of total billed charges for outpatient setting,$262.80 ,90% of total billed charges for outpatient setting,$271.56 ,93% of total billed charges for outpatient setting,$14.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$14.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$248.20 ,85% of total billed charges for outpatient setting,$262.80 ,90% of total billed charges for outpatient setting,$262.80 ,90% of total billed charges for outpatient setting,$14.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$254.04 ,87% of total billed charges for outpatient setting,$14.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$204.40 ,70% of total billed charges for outpatient setting,$8.17 ,$271.56 ,$233.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87340,Hepatitis B Surface AG,306,$98.50 ,$15.88 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$24.38 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$68.95 ,70% of total billed charges for outpatient setting,$88.65 ,90% of total billed charges for outpatient setting,$91.61 ,93% of total billed charges for outpatient setting,$16.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$16.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$83.73 ,85% of total billed charges for outpatient setting,$88.65 ,90% of total billed charges for outpatient setting,$88.65 ,90% of total billed charges for outpatient setting,$15.88 ,100% Medicaid OPPS fee schedule for outpatient setting,$85.70 ,87% of total billed charges for outpatient setting,$15.88 ,100% Medicaid OPPS fee schedule for outpatient setting,$10.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.95 ,70% of total billed charges for outpatient setting,$10.33 ,$91.61 ,$78.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80074,Hepatitis Panel,301,$242.50 ,$40.82 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$136.62 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$169.75 ,70% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$225.53 ,93% of total billed charges for outpatient setting,$41.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$41.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$206.13 ,85% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$218.25 ,90% of total billed charges for outpatient setting,$40.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$210.98 ,87% of total billed charges for outpatient setting,$40.82 ,100% Medicaid OPPS fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$169.75 ,70% of total billed charges for outpatient setting,$40.82 ,$225.53 ,$194.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86703,HIV Antibodies Screen w/Reflex,302,$116.00 ,$6.54 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.65 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$81.20 ,70% of total billed charges for outpatient setting,$104.40 ,90% of total billed charges for outpatient setting,$107.88 ,93% of total billed charges for outpatient setting,$6.61 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.61 ,101% Medicaid OPPS fee schedule for outpatient setting,$98.60 ,85% of total billed charges for outpatient setting,$104.40 ,90% of total billed charges for outpatient setting,$104.40 ,90% of total billed charges for outpatient setting,$6.54 ,100% Medicaid OPPS fee schedule for outpatient setting,$100.92 ,87% of total billed charges for outpatient setting,$6.54 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.20 ,70% of total billed charges for outpatient setting,$6.54 ,$107.88 ,$92.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87390,HIV P24 AG,306,$245.00 ,$13.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$59.43 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$171.50 ,70% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$227.85 ,93% of total billed charges for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$208.25 ,85% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$213.15 ,87% of total billed charges for outpatient setting,$13.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$24.06 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.50 ,70% of total billed charges for outpatient setting,$13.08 ,$227.85 ,$196.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82785,Immunoglobulin IGE,301,$97.50 ,$17.40 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$62.64 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$68.25 ,70% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$90.68 ,93% of total billed charges for outpatient setting,$17.57 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.57 ,101% Medicaid OPPS fee schedule for outpatient setting,$82.88 ,85% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$17.40 ,100% Medicaid OPPS fee schedule for outpatient setting,$84.83 ,87% of total billed charges for outpatient setting,$17.40 ,100% Medicaid OPPS fee schedule for outpatient setting,$16.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.25 ,70% of total billed charges for outpatient setting,$16.46 ,$90.68 ,$78.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87505,Infectious Agent Detection Digestive Tract,306,"$1,924.00 ",$194.15 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$277.17 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,"$1,346.80 ",70% of total billed charges for outpatient setting,"$1,731.60 ",90% of total billed charges for outpatient setting,"$1,789.32 ",93% of total billed charges for outpatient setting,$196.09 ,101% Medicaid OPPS fee schedule for outpatient setting,$196.09 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,635.40 ",85% of total billed charges for outpatient setting,"$1,731.60 ",90% of total billed charges for outpatient setting,"$1,731.60 ",90% of total billed charges for outpatient setting,$194.15 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,673.88 ",87% of total billed charges for outpatient setting,$194.15 ,100% Medicaid OPPS fee schedule for outpatient setting,$128.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,346.80 ",70% of total billed charges for outpatient setting,$128.29 ,"$1,789.32 ","$1,539.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87801,Infectious Agent Detection Multi Organisms Amp Prob,306,$625.50 ,$53.94 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$149.13 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$437.85 ,70% of total billed charges for outpatient setting,$562.95 ,90% of total billed charges for outpatient setting,$581.72 ,93% of total billed charges for outpatient setting,$54.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$54.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$531.68 ,85% of total billed charges for outpatient setting,$562.95 ,90% of total billed charges for outpatient setting,$562.95 ,90% of total billed charges for outpatient setting,$53.94 ,100% Medicaid OPPS fee schedule for outpatient setting,$544.19 ,87% of total billed charges for outpatient setting,$53.94 ,100% Medicaid OPPS fee schedule for outpatient setting,$70.20 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$437.85 ,70% of total billed charges for outpatient setting,$53.94 ,$581.72 ,$500.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87502,Influenza A&B Rapid,306,$167.00 ,$105.86 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$110.67 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$116.90 ,70% of total billed charges for outpatient setting,$150.30 ,90% of total billed charges for outpatient setting,$155.31 ,93% of total billed charges for outpatient setting,$106.92 ,101% Medicaid OPPS fee schedule for outpatient setting,$106.92 ,101% Medicaid OPPS fee schedule for outpatient setting,$141.95 ,85% of total billed charges for outpatient setting,$150.30 ,90% of total billed charges for outpatient setting,$150.30 ,90% of total billed charges for outpatient setting,$105.86 ,100% Medicaid OPPS fee schedule for outpatient setting,$145.29 ,87% of total billed charges for outpatient setting,$105.86 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.90 ,70% of total billed charges for outpatient setting,$95.80 ,$155.31 ,$133.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83540,Iron Serum,301,$114.50 ,$6.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$25.37 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$80.15 ,70% of total billed charges for outpatient setting,$103.05 ,90% of total billed charges for outpatient setting,$106.49 ,93% of total billed charges for outpatient setting,$6.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.88 ,101% Medicaid OPPS fee schedule for outpatient setting,$97.33 ,85% of total billed charges for outpatient setting,$103.05 ,90% of total billed charges for outpatient setting,$103.05 ,90% of total billed charges for outpatient setting,$6.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$99.62 ,87% of total billed charges for outpatient setting,$6.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$80.15 ,70% of total billed charges for outpatient setting,$6.47 ,$106.49 ,$91.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83605,Lactic Acid Serum,301,$189.50 ,$13.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$46.88 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$132.65 ,70% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$176.24 ,93% of total billed charges for outpatient setting,$13.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$161.08 ,85% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$13.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$164.87 ,87% of total billed charges for outpatient setting,$13.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.65 ,70% of total billed charges for outpatient setting,$11.57 ,$176.24 ,$151.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83615,LDH,301,$111.00 ,$10.32 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$22.55 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$77.70 ,70% of total billed charges for outpatient setting,$99.90 ,90% of total billed charges for outpatient setting,$103.23 ,93% of total billed charges for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$94.35 ,85% of total billed charges for outpatient setting,$99.90 ,90% of total billed charges for outpatient setting,$99.90 ,90% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$96.57 ,87% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.70 ,70% of total billed charges for outpatient setting,$6.04 ,$103.23 ,$88.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83655,Lead Blood Adult,301,$48.50 ,$15.31 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$24.12 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$33.95 ,70% of total billed charges for outpatient setting,$43.65 ,90% of total billed charges for outpatient setting,$45.11 ,93% of total billed charges for outpatient setting,$15.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$41.23 ,85% of total billed charges for outpatient setting,$43.65 ,90% of total billed charges for outpatient setting,$43.65 ,90% of total billed charges for outpatient setting,$15.31 ,100% Medicaid OPPS fee schedule for outpatient setting,$42.20 ,87% of total billed charges for outpatient setting,$15.31 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.95 ,70% of total billed charges for outpatient setting,$12.11 ,$45.11 ,$38.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83690,Lipase Serum,301,$55.50 ,$10.32 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$27.50 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$38.85 ,70% of total billed charges for outpatient setting,$49.95 ,90% of total billed charges for outpatient setting,$51.62 ,93% of total billed charges for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$47.18 ,85% of total billed charges for outpatient setting,$49.95 ,90% of total billed charges for outpatient setting,$49.95 ,90% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$48.29 ,87% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.85 ,70% of total billed charges for outpatient setting,$6.89 ,$51.62 ,$44.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80061,Lipid Profile B,301,$327.50 ,$19.78 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$42.75 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$229.25 ,70% of total billed charges for outpatient setting,$294.75 ,90% of total billed charges for outpatient setting,$304.58 ,93% of total billed charges for outpatient setting,$19.98 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.98 ,101% Medicaid OPPS fee schedule for outpatient setting,$278.38 ,85% of total billed charges for outpatient setting,$294.75 ,90% of total billed charges for outpatient setting,$294.75 ,90% of total billed charges for outpatient setting,$19.78 ,100% Medicaid OPPS fee schedule for outpatient setting,$284.93 ,87% of total billed charges for outpatient setting,$19.78 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$229.25 ,70% of total billed charges for outpatient setting,$13.39 ,$304.58 ,$262.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83735,Magnesium Level,301,$67.50 ,$10.99 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$25.59 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$47.25 ,70% of total billed charges for outpatient setting,$60.75 ,90% of total billed charges for outpatient setting,$62.78 ,93% of total billed charges for outpatient setting,$11.10 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.10 ,101% Medicaid OPPS fee schedule for outpatient setting,$57.38 ,85% of total billed charges for outpatient setting,$60.75 ,90% of total billed charges for outpatient setting,$60.75 ,90% of total billed charges for outpatient setting,$10.99 ,100% Medicaid OPPS fee schedule for outpatient setting,$58.73 ,87% of total billed charges for outpatient setting,$10.99 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.25 ,70% of total billed charges for outpatient setting,$6.70 ,$62.78 ,$54.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85007,Manual Differential,305,$49.00 ,$2.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$7.46 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$34.30 ,70% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$45.57 ,93% of total billed charges for outpatient setting,$2.77 ,101% Medicaid OPPS fee schedule for outpatient setting,$2.77 ,101% Medicaid OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$2.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$42.63 ,87% of total billed charges for outpatient setting,$2.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$2.74 ,$45.57 ,$39.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83050,Methemoglobin,301,$49.00 ,$7.85 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$17.67 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$34.30 ,70% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$45.57 ,93% of total billed charges for outpatient setting,$7.93 ,101% Medicaid OPPS fee schedule for outpatient setting,$7.93 ,101% Medicaid OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$7.85 ,100% Medicaid OPPS fee schedule for outpatient setting,$42.63 ,87% of total billed charges for outpatient setting,$7.85 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$7.85 ,$45.57 ,$39.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82043,Microalbumin 24 Hr Urine,307,$92.00 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$24.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$64.40 ,70% of total billed charges for outpatient setting,$82.80 ,90% of total billed charges for outpatient setting,$85.56 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$78.20 ,85% of total billed charges for outpatient setting,$82.80 ,90% of total billed charges for outpatient setting,$82.80 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$80.04 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.40 ,70% of total billed charges for outpatient setting,$5.78 ,$85.56 ,$73.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86308,Mononucleosis Screen,302,$161.00 ,$9.36 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$19.31 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$112.70 ,70% of total billed charges for outpatient setting,$144.90 ,90% of total billed charges for outpatient setting,$149.73 ,93% of total billed charges for outpatient setting,$9.45 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.45 ,101% Medicaid OPPS fee schedule for outpatient setting,$136.85 ,85% of total billed charges for outpatient setting,$144.90 ,90% of total billed charges for outpatient setting,$144.90 ,90% of total billed charges for outpatient setting,$9.36 ,100% Medicaid OPPS fee schedule for outpatient setting,$140.07 ,87% of total billed charges for outpatient setting,$9.36 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$112.70 ,70% of total billed charges for outpatient setting,$5.18 ,$149.73 ,$128.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87591,N Gonorrhoeae DNA Amp Probe,306,$162.50 ,$53.93 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$74.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$113.75 ,70% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$151.13 ,93% of total billed charges for outpatient setting,$54.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$54.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$138.13 ,85% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$146.25 ,90% of total billed charges for outpatient setting,$53.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$141.38 ,87% of total billed charges for outpatient setting,$53.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.75 ,70% of total billed charges for outpatient setting,$35.09 ,$151.13 ,$130.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82270,Occult Blood Stool,301,$25.50 ,$4.99 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$12.29 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$17.85 ,70% of total billed charges for outpatient setting,$22.95 ,90% of total billed charges for outpatient setting,$23.72 ,93% of total billed charges for outpatient setting,$5.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$5.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.68 ,85% of total billed charges for outpatient setting,$22.95 ,90% of total billed charges for outpatient setting,$22.95 ,90% of total billed charges for outpatient setting,$4.99 ,100% Medicaid OPPS fee schedule for outpatient setting,$22.19 ,87% of total billed charges for outpatient setting,$4.99 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.85 ,70% of total billed charges for outpatient setting,$4.38 ,$23.72 ,$20.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,83970,Parathyroid Hormone,301,$725.50 ,$30.22 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$153.48 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$507.85 ,70% of total billed charges for outpatient setting,$652.95 ,90% of total billed charges for outpatient setting,$674.72 ,93% of total billed charges for outpatient setting,$30.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$30.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$616.68 ,85% of total billed charges for outpatient setting,$652.95 ,90% of total billed charges for outpatient setting,$652.95 ,90% of total billed charges for outpatient setting,$30.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$631.19 ,87% of total billed charges for outpatient setting,$30.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$507.85 ,70% of total billed charges for outpatient setting,$30.22 ,$674.72 ,$580.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84100,Phosphorous Inorganic,301,$99.00 ,$8.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$10.08 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$69.30 ,70% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$92.07 ,93% of total billed charges for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$84.15 ,85% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$89.10 ,90% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$86.13 ,87% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$69.30 ,70% of total billed charges for outpatient setting,$4.74 ,$92.07 ,$79.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85049,Platelet Count,305,$30.50 ,$11.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$15.03 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$21.35 ,70% of total billed charges for outpatient setting,$27.45 ,90% of total billed charges for outpatient setting,$28.37 ,93% of total billed charges for outpatient setting,$11.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$25.93 ,85% of total billed charges for outpatient setting,$27.45 ,90% of total billed charges for outpatient setting,$27.45 ,90% of total billed charges for outpatient setting,$11.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$26.54 ,87% of total billed charges for outpatient setting,$11.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.35 ,70% of total billed charges for outpatient setting,$4.48 ,$28.37 ,$24.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84132,Potassium Serum,301,$83.00 ,$5.50 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$9.77 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$58.10 ,70% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$77.19 ,93% of total billed charges for outpatient setting,$5.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$5.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$70.55 ,85% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$74.70 ,90% of total billed charges for outpatient setting,$5.50 ,100% Medicaid OPPS fee schedule for outpatient setting,$72.21 ,87% of total billed charges for outpatient setting,$5.50 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.10 ,70% of total billed charges for outpatient setting,$4.76 ,$77.19 ,$66.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84703,Pregnancy Test Serum Qualitative,301,$108.50 ,$11.77 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$33.98 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$75.95 ,70% of total billed charges for outpatient setting,$97.65 ,90% of total billed charges for outpatient setting,$100.91 ,93% of total billed charges for outpatient setting,$11.89 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.89 ,101% Medicaid OPPS fee schedule for outpatient setting,$92.23 ,85% of total billed charges for outpatient setting,$97.65 ,90% of total billed charges for outpatient setting,$97.65 ,90% of total billed charges for outpatient setting,$11.77 ,100% Medicaid OPPS fee schedule for outpatient setting,$94.40 ,87% of total billed charges for outpatient setting,$11.77 ,100% Medicaid OPPS fee schedule for outpatient setting,$7.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.95 ,70% of total billed charges for outpatient setting,$7.52 ,$100.91 ,$86.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,81025,Pregnancy Test Urine Qualitative,307,$189.00 ,$9.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$26.87 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$132.30 ,70% of total billed charges for outpatient setting,$170.10 ,90% of total billed charges for outpatient setting,$175.77 ,93% of total billed charges for outpatient setting,$9.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$160.65 ,85% of total billed charges for outpatient setting,$170.10 ,90% of total billed charges for outpatient setting,$170.10 ,90% of total billed charges for outpatient setting,$9.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$164.43 ,87% of total billed charges for outpatient setting,$9.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.30 ,70% of total billed charges for outpatient setting,$8.61 ,$175.77 ,$151.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84145,Procalcitonin,301,$168.50 ,$30.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$91.03 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$117.95 ,70% of total billed charges for outpatient setting,$151.65 ,90% of total billed charges for outpatient setting,$156.71 ,93% of total billed charges for outpatient setting,$31.18 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.18 ,101% Medicaid OPPS fee schedule for outpatient setting,$143.23 ,85% of total billed charges for outpatient setting,$151.65 ,90% of total billed charges for outpatient setting,$151.65 ,90% of total billed charges for outpatient setting,$30.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$146.60 ,87% of total billed charges for outpatient setting,$30.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$27.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.95 ,70% of total billed charges for outpatient setting,$27.22 ,$156.71 ,$134.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84153,Prostate Specific AG Total,301,$189.50 ,$28.27 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$67.28 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$132.65 ,70% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$176.24 ,93% of total billed charges for outpatient setting,$28.55 ,101% Medicaid OPPS fee schedule for outpatient setting,$28.55 ,101% Medicaid OPPS fee schedule for outpatient setting,$161.08 ,85% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$170.55 ,90% of total billed charges for outpatient setting,$28.27 ,100% Medicaid OPPS fee schedule for outpatient setting,$164.87 ,87% of total billed charges for outpatient setting,$28.27 ,100% Medicaid OPPS fee schedule for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.65 ,70% of total billed charges for outpatient setting,$18.39 ,$176.24 ,$151.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84155,Protein 24 Hr Urine,301,$127.50 ,$6.60 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$8.55 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$89.25 ,70% of total billed charges for outpatient setting,$114.75 ,90% of total billed charges for outpatient setting,$118.58 ,93% of total billed charges for outpatient setting,$6.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$108.38 ,85% of total billed charges for outpatient setting,$114.75 ,90% of total billed charges for outpatient setting,$114.75 ,90% of total billed charges for outpatient setting,$6.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$110.93 ,87% of total billed charges for outpatient setting,$6.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$89.25 ,70% of total billed charges for outpatient setting,$3.67 ,$118.58 ,$102.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84156,Protein Total,301,$97.50 ,$6.60 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$18.63 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$68.25 ,70% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$90.68 ,93% of total billed charges for outpatient setting,$6.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$82.88 ,85% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$87.75 ,90% of total billed charges for outpatient setting,$6.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$84.83 ,87% of total billed charges for outpatient setting,$6.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.25 ,70% of total billed charges for outpatient setting,$3.67 ,$90.68 ,$78.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85610,Prothrombin Time,305,$73.00 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$15.92 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$51.10 ,70% of total billed charges for outpatient setting,$65.70 ,90% of total billed charges for outpatient setting,$67.89 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$65.70 ,90% of total billed charges for outpatient setting,$65.70 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$63.51 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.10 ,70% of total billed charges for outpatient setting,$4.29 ,$67.89 ,$58.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85730,PTT,305,$57.00 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$22.31 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$39.90 ,70% of total billed charges for outpatient setting,$51.30 ,90% of total billed charges for outpatient setting,$53.01 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$48.45 ,85% of total billed charges for outpatient setting,$51.30 ,90% of total billed charges for outpatient setting,$51.30 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$49.59 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.90 ,70% of total billed charges for outpatient setting,$6.01 ,$53.01 ,$45.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,81511,Quadscreen,300,$333.00 ,N/A,Not separately reimbursable per CMS guidelines,$213.18 ,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$233.10 ,70% of total billed charges for outpatient setting,$299.70 ,90% of total billed charges for outpatient setting,$309.69 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$283.05 ,85% of total billed charges for outpatient setting,$299.70 ,90% of total billed charges for outpatient setting,$299.70 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$289.71 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$153.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$233.10 ,70% of total billed charges for outpatient setting,$153.50 ,$309.69 ,$266.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86901,RH Type,300,$56.50 ,$6.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$16.07 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$39.55 ,70% of total billed charges for outpatient setting,$50.85 ,90% of total billed charges for outpatient setting,$52.55 ,93% of total billed charges for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.94 ,101% Medicaid OPPS fee schedule for outpatient setting,$48.03 ,85% of total billed charges for outpatient setting,$50.85 ,90% of total billed charges for outpatient setting,$50.85 ,90% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$49.16 ,87% of total billed charges for outpatient setting,$6.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$30.36 ,pay at 100% of APC for outpatient setting,$39.55 ,70% of total billed charges for outpatient setting,$6.87 ,$52.55 ,$45.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86431,Rheumatoid Arthritis Factor,302,$60.00 ,$10.11 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$25.49 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$42.00 ,70% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$55.80 ,93% of total billed charges for outpatient setting,$10.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$10.21 ,101% Medicaid OPPS fee schedule for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$10.11 ,100% Medicaid OPPS fee schedule for outpatient setting,$52.20 ,87% of total billed charges for outpatient setting,$10.11 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.00 ,70% of total billed charges for outpatient setting,$5.67 ,$55.80 ,$48.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87634,RSV Rapid,306,$201.50 ,$76.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$155.99 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$141.05 ,70% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$187.40 ,93% of total billed charges for outpatient setting,$77.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$77.48 ,101% Medicaid OPPS fee schedule for outpatient setting,$171.28 ,85% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$76.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$175.31 ,87% of total billed charges for outpatient setting,$76.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$70.20 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$141.05 ,70% of total billed charges for outpatient setting,$70.20 ,$187.40 ,$161.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86762,Rubella Antibodies IGM,302,$70.50 ,$9.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$30.59 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$49.35 ,70% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$65.57 ,93% of total billed charges for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$59.93 ,85% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$63.45 ,90% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$61.34 ,87% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$14.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.35 ,70% of total billed charges for outpatient setting,$9.81 ,$65.57 ,$56.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87635,SARS Covid RNA Qualitative PCR,306,$161.50 ,$43.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$113.05 ,70% of total billed charges for outpatient setting,$145.35 ,90% of total billed charges for outpatient setting,$150.20 ,93% of total billed charges for outpatient setting,$44.05 ,101% Medicaid OPPS fee schedule for outpatient setting,$44.05 ,101% Medicaid OPPS fee schedule for outpatient setting,$137.28 ,85% of total billed charges for outpatient setting,$145.35 ,90% of total billed charges for outpatient setting,$145.35 ,90% of total billed charges for outpatient setting,$43.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$140.51 ,87% of total billed charges for outpatient setting,$43.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$51.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.05 ,70% of total billed charges for outpatient setting,$43.61 ,$150.20 ,$129.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,85651,Sedimentation Rate-W,305,$76.00 ,$6.43 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$13.11 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$53.20 ,70% of total billed charges for outpatient setting,$68.40 ,90% of total billed charges for outpatient setting,$70.68 ,93% of total billed charges for outpatient setting,$6.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$64.60 ,85% of total billed charges for outpatient setting,$68.40 ,90% of total billed charges for outpatient setting,$68.40 ,90% of total billed charges for outpatient setting,$6.43 ,100% Medicaid OPPS fee schedule for outpatient setting,$66.12 ,87% of total billed charges for outpatient setting,$6.43 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.20 ,70% of total billed charges for outpatient setting,$4.26 ,$70.68 ,$60.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87802,Step B Assay,306,$133.50 ,$9.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$60.35 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$93.45 ,70% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$124.16 ,93% of total billed charges for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$113.48 ,85% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$120.15 ,90% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$116.15 ,87% of total billed charges for outpatient setting,$9.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.45 ,70% of total billed charges for outpatient setting,$9.81 ,$124.16 ,$106.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87081,Strep Screen,306,$158.00 ,$9.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$23.72 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$110.60 ,70% of total billed charges for outpatient setting,$142.20 ,90% of total billed charges for outpatient setting,$146.94 ,93% of total billed charges for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$9.71 ,101% Medicaid OPPS fee schedule for outpatient setting,$134.30 ,85% of total billed charges for outpatient setting,$142.20 ,90% of total billed charges for outpatient setting,$142.20 ,90% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$137.46 ,87% of total billed charges for outpatient setting,$9.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$110.60 ,70% of total billed charges for outpatient setting,$6.63 ,$146.94 ,$126.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87186,Susceptibility Test,306,$226.00 ,$15.64 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$32.61 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$158.20 ,70% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$210.18 ,93% of total billed charges for outpatient setting,$15.80 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.80 ,101% Medicaid OPPS fee schedule for outpatient setting,$192.10 ,85% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$203.40 ,90% of total billed charges for outpatient setting,$15.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$196.62 ,87% of total billed charges for outpatient setting,$15.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.20 ,70% of total billed charges for outpatient setting,$8.65 ,$210.18 ,$180.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84481,T3 Free Serum,301,$381.00 ,$30.64 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$83.42 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$266.70 ,70% of total billed charges for outpatient setting,$342.90 ,90% of total billed charges for outpatient setting,$354.33 ,93% of total billed charges for outpatient setting,$30.95 ,101% Medicaid OPPS fee schedule for outpatient setting,$30.95 ,101% Medicaid OPPS fee schedule for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$342.90 ,90% of total billed charges for outpatient setting,$342.90 ,90% of total billed charges for outpatient setting,$30.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$331.47 ,87% of total billed charges for outpatient setting,$30.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$16.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$266.70 ,70% of total billed charges for outpatient setting,$16.94 ,$354.33 ,$304.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84479,T3 Uptake,301,$37.00 ,$10.32 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$18.65 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$25.90 ,70% of total billed charges for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$34.41 ,93% of total billed charges for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$32.19 ,87% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$6.47 ,$34.41 ,$29.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84436,T4,301,$77.00 ,$10.32 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$17.78 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$53.90 ,70% of total billed charges for outpatient setting,$69.30 ,90% of total billed charges for outpatient setting,$71.61 ,93% of total billed charges for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$10.42 ,101% Medicaid OPPS fee schedule for outpatient setting,$65.45 ,85% of total billed charges for outpatient setting,$69.30 ,90% of total billed charges for outpatient setting,$69.30 ,90% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$66.99 ,87% of total billed charges for outpatient setting,$10.32 ,100% Medicaid OPPS fee schedule for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.90 ,70% of total billed charges for outpatient setting,$6.87 ,$71.61 ,$61.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84439,T4 Free Direct Serum,301,$123.50 ,$15.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$30.47 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$86.45 ,70% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$114.86 ,93% of total billed charges for outpatient setting,$15.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$104.98 ,85% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$15.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$107.45 ,87% of total billed charges for outpatient setting,$15.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.45 ,70% of total billed charges for outpatient setting,$9.02 ,$114.86 ,$98.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86480,TB Gold Quantiferon,302,$194.00 ,$96.29 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$131.68 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$135.80 ,70% of total billed charges for outpatient setting,$174.60 ,90% of total billed charges for outpatient setting,$180.42 ,93% of total billed charges for outpatient setting,$97.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$97.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$164.90 ,85% of total billed charges for outpatient setting,$174.60 ,90% of total billed charges for outpatient setting,$174.60 ,90% of total billed charges for outpatient setting,$96.29 ,100% Medicaid OPPS fee schedule for outpatient setting,$168.78 ,87% of total billed charges for outpatient setting,$96.29 ,100% Medicaid OPPS fee schedule for outpatient setting,$61.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.80 ,70% of total billed charges for outpatient setting,$61.98 ,$180.42 ,$155.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84402,Testosterone Free,301,$202.50 ,$40.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$107.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$141.75 ,70% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$188.33 ,93% of total billed charges for outpatient setting,$40.57 ,101% Medicaid OPPS fee schedule for outpatient setting,$40.57 ,101% Medicaid OPPS fee schedule for outpatient setting,$172.13 ,85% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$40.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$176.18 ,87% of total billed charges for outpatient setting,$40.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$141.75 ,70% of total billed charges for outpatient setting,$25.47 ,$188.33 ,$162.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84403,Testosterone Total,301,$202.50 ,$40.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$103.82 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$141.75 ,70% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$188.33 ,93% of total billed charges for outpatient setting,$40.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$40.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$172.13 ,85% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$182.25 ,90% of total billed charges for outpatient setting,$40.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$176.18 ,87% of total billed charges for outpatient setting,$40.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$141.75 ,70% of total billed charges for outpatient setting,$25.81 ,$188.33 ,$162.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84466,Transferrin,301,$113.50 ,$17.86 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$77.16 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$79.45 ,70% of total billed charges for outpatient setting,$102.15 ,90% of total billed charges for outpatient setting,$105.56 ,93% of total billed charges for outpatient setting,$18.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$18.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$96.48 ,85% of total billed charges for outpatient setting,$102.15 ,90% of total billed charges for outpatient setting,$102.15 ,90% of total billed charges for outpatient setting,$17.86 ,100% Medicaid OPPS fee schedule for outpatient setting,$98.75 ,87% of total billed charges for outpatient setting,$17.86 ,100% Medicaid OPPS fee schedule for outpatient setting,$12.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.45 ,70% of total billed charges for outpatient setting,$12.76 ,$105.56 ,$90.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,86780,Treponema Pallidum Antibody,302,$124.00 ,$21.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$52.58 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$86.80 ,70% of total billed charges for outpatient setting,$111.60 ,90% of total billed charges for outpatient setting,$115.32 ,93% of total billed charges for outpatient setting,$21.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$105.40 ,85% of total billed charges for outpatient setting,$111.60 ,90% of total billed charges for outpatient setting,$111.60 ,90% of total billed charges for outpatient setting,$21.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$107.88 ,87% of total billed charges for outpatient setting,$21.08 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.80 ,70% of total billed charges for outpatient setting,$13.24 ,$115.32 ,$99.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,87661,Trichomonas Qualitative,306,$407.50 ,N/A,Not separately reimbursable per CMS guidelines,$94.55 ,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$285.25 ,70% of total billed charges for outpatient setting,$366.75 ,90% of total billed charges for outpatient setting,$378.98 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$346.38 ,85% of total billed charges for outpatient setting,$366.75 ,90% of total billed charges for outpatient setting,$366.75 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$354.53 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$285.25 ,70% of total billed charges for outpatient setting,$35.09 ,$378.98 ,$326.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84478,Triglycerides,301,$112.00 ,$8.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$12.23 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$78.40 ,70% of total billed charges for outpatient setting,$100.80 ,90% of total billed charges for outpatient setting,$104.16 ,93% of total billed charges for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.32 ,101% Medicaid OPPS fee schedule for outpatient setting,$95.20 ,85% of total billed charges for outpatient setting,$100.80 ,90% of total billed charges for outpatient setting,$100.80 ,90% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$97.44 ,87% of total billed charges for outpatient setting,$8.24 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.40 ,70% of total billed charges for outpatient setting,$5.74 ,$104.16 ,$89.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84512,Troponin I Qualitative,301,$295.00 ,$15.70 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$67.91 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$206.50 ,70% of total billed charges for outpatient setting,$265.50 ,90% of total billed charges for outpatient setting,$274.35 ,93% of total billed charges for outpatient setting,$15.86 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.86 ,101% Medicaid OPPS fee schedule for outpatient setting,$250.75 ,85% of total billed charges for outpatient setting,$265.50 ,90% of total billed charges for outpatient setting,$265.50 ,90% of total billed charges for outpatient setting,$15.70 ,100% Medicaid OPPS fee schedule for outpatient setting,$256.65 ,87% of total billed charges for outpatient setting,$15.70 ,100% Medicaid OPPS fee schedule for outpatient setting,$10.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$206.50 ,70% of total billed charges for outpatient setting,$10.09 ,$274.35 ,$236.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84443,TSH,301,$123.50 ,$20.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.53 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$86.45 ,70% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$114.86 ,93% of total billed charges for outpatient setting,$20.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$20.82 ,101% Medicaid OPPS fee schedule for outpatient setting,$104.98 ,85% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$111.15 ,90% of total billed charges for outpatient setting,$20.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$107.45 ,87% of total billed charges for outpatient setting,$20.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.45 ,70% of total billed charges for outpatient setting,$16.80 ,$114.86 ,$98.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,84550,Uric Acid Blood,301,$81.50 ,$8.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$14.57 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$57.05 ,70% of total billed charges for outpatient setting,$73.35 ,90% of total billed charges for outpatient setting,$75.80 ,93% of total billed charges for outpatient setting,$8.26 ,101% Medicaid OPPS fee schedule for outpatient setting,$8.26 ,101% Medicaid OPPS fee schedule for outpatient setting,$69.28 ,85% of total billed charges for outpatient setting,$73.35 ,90% of total billed charges for outpatient setting,$73.35 ,90% of total billed charges for outpatient setting,$8.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$70.91 ,87% of total billed charges for outpatient setting,$8.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.05 ,70% of total billed charges for outpatient setting,$4.51 ,$75.80 ,$65.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,81001,Urinalysis Automated w/Microscope,307,$121.50 ,$5.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$9.62 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$85.05 ,70% of total billed charges for outpatient setting,$109.35 ,90% of total billed charges for outpatient setting,$113.00 ,93% of total billed charges for outpatient setting,$5.77 ,101% Medicaid OPPS fee schedule for outpatient setting,$5.77 ,101% Medicaid OPPS fee schedule for outpatient setting,$103.28 ,85% of total billed charges for outpatient setting,$109.35 ,90% of total billed charges for outpatient setting,$109.35 ,90% of total billed charges for outpatient setting,$5.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$105.71 ,87% of total billed charges for outpatient setting,$5.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.05 ,70% of total billed charges for outpatient setting,$3.17 ,$113.00 ,$97.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,81003,Urinalysis Automated w/o Microscope,307,$79.50 ,$1.96 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$9.11 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$55.65 ,70% of total billed charges for outpatient setting,$71.55 ,90% of total billed charges for outpatient setting,$73.94 ,93% of total billed charges for outpatient setting,$1.98 ,101% Medicaid OPPS fee schedule for outpatient setting,$1.98 ,101% Medicaid OPPS fee schedule for outpatient setting,$67.58 ,85% of total billed charges for outpatient setting,$71.55 ,90% of total billed charges for outpatient setting,$71.55 ,90% of total billed charges for outpatient setting,$1.96 ,100% Medicaid OPPS fee schedule for outpatient setting,$69.17 ,87% of total billed charges for outpatient setting,$1.96 ,100% Medicaid OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.65 ,70% of total billed charges for outpatient setting,$1.96 ,$73.94 ,$63.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,81050,Urine Volume Measure Timed Collection,307,$44.50 ,N/A,Not separately reimbursable per CMS guidelines,$10.49 ,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$31.15 ,70% of total billed charges for outpatient setting,$40.05 ,90% of total billed charges for outpatient setting,$41.39 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$37.83 ,85% of total billed charges for outpatient setting,$40.05 ,90% of total billed charges for outpatient setting,$40.05 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$38.72 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$3.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.15 ,70% of total billed charges for outpatient setting,$3.64 ,$41.39 ,$35.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,80202,Vancomycin Trough,301,$207.00 ,$24.49 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$58.38 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$144.90 ,70% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$192.51 ,93% of total billed charges for outpatient setting,$24.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$24.73 ,101% Medicaid OPPS fee schedule for outpatient setting,$175.95 ,85% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$186.30 ,90% of total billed charges for outpatient setting,$24.49 ,100% Medicaid OPPS fee schedule for outpatient setting,$180.09 ,87% of total billed charges for outpatient setting,$24.49 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$144.90 ,70% of total billed charges for outpatient setting,$13.54 ,$192.51 ,$165.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,36415,Venipuncture / Blood Draw,300,$34.50 ,N/A,Not separately reimbursable per CMS guidelines,$11.93 ,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$24.15 ,70% of total billed charges for outpatient setting,$31.05 ,90% of total billed charges for outpatient setting,$32.09 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$29.33 ,85% of total billed charges for outpatient setting,$25.88 ,90% of total billed charges for outpatient setting,$31.05 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$30.02 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$8.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.15 ,70% of total billed charges for outpatient setting,$8.57 ,$32.09 ,$27.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82607,Vitamin B12,301,$170.50 ,$27.25 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$56.84 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$119.35 ,70% of total billed charges for outpatient setting,$153.45 ,90% of total billed charges for outpatient setting,$158.57 ,93% of total billed charges for outpatient setting,$27.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$27.52 ,101% Medicaid OPPS fee schedule for outpatient setting,$144.93 ,85% of total billed charges for outpatient setting,$153.45 ,90% of total billed charges for outpatient setting,$153.45 ,90% of total billed charges for outpatient setting,$27.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$148.34 ,87% of total billed charges for outpatient setting,$27.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$119.35 ,70% of total billed charges for outpatient setting,$15.08 ,$158.57 ,$136.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LABORATORY,82306,Vitamin D 25-Hydrox,301,$370.00 ,$13.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$216.27 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$259.00 ,70% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,$344.10 ,93% of total billed charges for outpatient setting,$13.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$314.50 ,85% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,$13.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$321.90 ,87% of total billed charges for outpatient setting,$13.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$259.00 ,70% of total billed charges for outpatient setting,$13.18 ,$344.10 ,$296.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,29848,Carpal Tunnel Release,360,"$14,093.94 ",$654.16 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$2,679.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,054.39 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$9,865.76 ",70% of total billed charges for outpatient setting,"$12,684.55 ",90% of total billed charges for outpatient setting,"$13,107.36 ",93% of total billed charges for outpatient setting,$660.70 ,101% Medicaid OPPS fee schedule for outpatient setting,$660.70 ,101% Medicaid OPPS fee schedule for outpatient setting,"$11,979.85 ",85% of total billed charges for outpatient setting,"$10,570.46 ",90% of total billed charges for outpatient setting,"$12,684.55 ",90% of total billed charges for outpatient setting,$654.16 ,100% Medicaid OPPS fee schedule for outpatient setting,"$12,261.73 ",87% of total billed charges for outpatient setting,$654.16 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,282.77 ",pay at 100% of APC for outpatient setting,"$9,865.76 ",70% of total billed charges for outpatient setting,$654.16 ,"$13,107.36 ","$11,275.15 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,54150,Circumcision Newborn,761,"$2,470.00 ",$327.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$289.00 ,100% of BCBS Fee schedule for outpatient setting,$201.06 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,729.00 ",70% of total billed charges for outpatient setting,"$2,223.00 ",90% of total billed charges for outpatient setting,"$2,297.10 ",93% of total billed charges for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,099.50 ",85% of total billed charges for outpatient setting,"$1,852.50 ",90% of total billed charges for outpatient setting,"$2,223.00 ",90% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,148.90 ",87% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,658.67 ",pay at 100% of APC for outpatient setting,"$1,729.00 ",70% of total billed charges for outpatient setting,$201.06 ,"$2,297.10 ","$1,976.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,54161,Circumcision Adult,360,"$12,897.00 ",$327.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$2,724.00 ",100% of BCBS Fee schedule for outpatient setting,$409.11 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$9,027.90 ",70% of total billed charges for outpatient setting,"$11,607.30 ",90% of total billed charges for outpatient setting,"$11,994.21 ",93% of total billed charges for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,"$10,962.45 ",85% of total billed charges for outpatient setting,"$9,672.75 ",90% of total billed charges for outpatient setting,"$11,607.30 ",90% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$11,220.39 ",87% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,658.67 ",pay at 100% of APC for outpatient setting,"$9,027.90 ",70% of total billed charges for outpatient setting,$327.08 ,"$11,994.21 ","$10,317.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Colonoscopy Diagnostic,360,"$9,189.60 ",$294.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,308.00 ",100% of BCBS Fee schedule for outpatient setting,$382.43 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$6,432.72 ",70% of total billed charges for outpatient setting,"$8,270.64 ",90% of total billed charges for outpatient setting,"$8,546.33 ",93% of total billed charges for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,"$7,811.16 ",85% of total billed charges for outpatient setting,"$3,771.52 ",Case Rate,"$8,270.64 ",90% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,"$7,994.95 ",87% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$743.13 ,pay at 100% of APC for outpatient setting,"$6,432.72 ",70% of total billed charges for outpatient setting,$294.37 ,"$8,546.33 ","$7,351.68 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,45380,Colonoscopy with Biopsy,360,"$10,124.44 ",$294.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,350.00 ",100% of BCBS Fee schedule for outpatient setting,$415.98 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$7,087.11 ",70% of total billed charges for outpatient setting,"$9,112.00 ",90% of total billed charges for outpatient setting,"$9,415.73 ",93% of total billed charges for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,"$8,605.77 ",85% of total billed charges for outpatient setting,"$3,771.52 ",Case Rate,"$9,112.00 ",90% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,"$8,808.26 ",87% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$968.36 ,pay at 100% of APC for outpatient setting,"$7,087.11 ",70% of total billed charges for outpatient setting,$294.37 ,"$9,415.73 ","$8,099.55 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,11042,Debridement minor < 20sqcm,761,$875.10 ,$261.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$276.00 ,100% of BCBS Fee schedule for outpatient setting,$124.63 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$612.57 ,70% of total billed charges for outpatient setting,$787.59 ,90% of total billed charges for outpatient setting,$813.84 ,93% of total billed charges for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$743.84 ,85% of total billed charges for outpatient setting,$656.33 ,90% of total billed charges for outpatient setting,$787.59 ,90% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$761.34 ,87% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$333.60 ,pay at 100% of APC for outpatient setting,$612.57 ,70% of total billed charges for outpatient setting,$124.63 ,$813.84 ,$700.08 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,11045,Debridement minor each additional 20sqcm,761,$551.50 ,$127.20 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$276.00 ,100% of BCBS Fee schedule for outpatient setting,$53.64 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$386.05 ,70% of total billed charges for outpatient setting,$496.35 ,90% of total billed charges for outpatient setting,$512.90 ,93% of total billed charges for outpatient setting,$128.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$128.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$468.78 ,85% of total billed charges for outpatient setting,$413.63 ,90% of total billed charges for outpatient setting,$496.35 ,90% of total billed charges for outpatient setting,$127.20 ,100% Medicaid OPPS fee schedule for outpatient setting,$479.81 ,87% of total billed charges for outpatient setting,$127.20 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$386.05 ,70% of total billed charges for outpatient setting,$53.64 ,$512.90 ,$441.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,11043,Debridement muscle < 20sqcm,761,"$1,183.72 ",$261.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$276.00 ,100% of BCBS Fee schedule for outpatient setting,$316.62 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$828.60 ,70% of total billed charges for outpatient setting,"$1,065.35 ",90% of total billed charges for outpatient setting,"$1,100.86 ",93% of total billed charges for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,006.16 ",85% of total billed charges for outpatient setting,$887.79 ,90% of total billed charges for outpatient setting,"$1,065.35 ",90% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,029.84 ",87% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$519.49 ,pay at 100% of APC for outpatient setting,$828.60 ,70% of total billed charges for outpatient setting,$261.66 ,"$1,100.86 ",$946.98 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,11046,Debridement muscle each additional 20sqcm,761,$947.50 ,$127.20 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$276.00 ,100% of BCBS Fee schedule for outpatient setting,$113.04 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$663.25 ,70% of total billed charges for outpatient setting,$852.75 ,90% of total billed charges for outpatient setting,$881.18 ,93% of total billed charges for outpatient setting,$128.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$128.47 ,101% Medicaid OPPS fee schedule for outpatient setting,$805.38 ,85% of total billed charges for outpatient setting,$710.63 ,90% of total billed charges for outpatient setting,$852.75 ,90% of total billed charges for outpatient setting,$127.20 ,100% Medicaid OPPS fee schedule for outpatient setting,$824.33 ,87% of total billed charges for outpatient setting,$127.20 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$663.25 ,70% of total billed charges for outpatient setting,$113.04 ,$881.18 ,$758.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,97602,Debridement non-selective,761,$617.50 ,$261.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable,$432.25 ,70% of total billed charges for outpatient setting,$555.75 ,90% of total billed charges for outpatient setting,$574.28 ,93% of total billed charges for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$264.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$524.88 ,85% of total billed charges for outpatient setting,$555.75 ,90% of total billed charges for outpatient setting,$555.75 ,90% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$537.23 ,87% of total billed charges for outpatient setting,$261.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$161.47 ,pay at 100% of APC for outpatient setting,$432.25 ,70% of total billed charges for outpatient setting,$161.47 ,$574.28 ,$494.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,43450,Dilate Esophagus,360,"$10,888.50 ",$294.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$812.00 ,100% of BCBS Fee schedule for outpatient setting,$164.54 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$7,621.95 ",70% of total billed charges for outpatient setting,"$9,799.65 ",90% of total billed charges for outpatient setting,"$10,126.31 ",93% of total billed charges for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,"$9,255.23 ",85% of total billed charges for outpatient setting,"$8,166.38 ",90% of total billed charges for outpatient setting,"$9,799.65 ",90% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,"$9,473.00 ",87% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$738.18 ,pay at 100% of APC for outpatient setting,"$7,621.95 ",70% of total billed charges for outpatient setting,$164.54 ,"$10,126.31 ","$8,710.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,43239,EGD with Biopsy,360,"$10,062.91 ",$294.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,142.00 ",100% of BCBS Fee schedule for outpatient setting,$286.77 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$7,044.04 ",70% of total billed charges for outpatient setting,"$9,056.62 ",90% of total billed charges for outpatient setting,"$9,358.51 ",93% of total billed charges for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,$297.31 ,101% Medicaid OPPS fee schedule for outpatient setting,"$8,553.47 ",85% of total billed charges for outpatient setting,"$7,547.18 ",90% of total billed charges for outpatient setting,"$9,056.62 ",90% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,"$8,754.73 ",87% of total billed charges for outpatient setting,$294.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$738.18 ,pay at 100% of APC for outpatient setting,"$7,044.04 ",70% of total billed charges for outpatient setting,$286.77 ,"$9,358.51 ","$8,050.33 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,49593,Hernia Ventrical/Abdomin Repair,360,"$30,461.60 ",N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$24,369.28 ",80% of total billed charges for outpatient setting,"$21,323.12 ",70% of total billed charges for outpatient setting,"$27,415.44 ",90% of total billed charges for outpatient setting,"$28,329.29 ",93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$25,892.36 ",85% of total billed charges for outpatient setting,"$22,846.20 ",90% of total billed charges for outpatient setting,"$27,415.44 ",90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$26,501.59 ",87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$3,167.26 ",pay at 100% of APC for outpatient setting,"$21,323.12 ",70% of total billed charges for outpatient setting,"$3,167.26 ","$28,329.29 ","$24,369.28 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Hernia Inguinal Repair,360,"$24,147.03 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$3,774.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,070.48 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$16,902.92 ",70% of total billed charges for outpatient setting,"$21,732.33 ",90% of total billed charges for outpatient setting,"$22,456.74 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$20,524.98 ",85% of total billed charges for outpatient setting,"$18,110.27 ",90% of total billed charges for outpatient setting,"$21,732.33 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$21,007.92 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$3,167.26 ",pay at 100% of APC for outpatient setting,"$16,902.92 ",70% of total billed charges for outpatient setting,$569.12 ,"$22,456.74 ","$19,317.62 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,G0277,Hyperbaric Oxygen Chamber 30 min,413,$551.50 ,$92.90 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$360.16 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$386.05 ,70% of total billed charges for outpatient setting,$496.35 ,90% of total billed charges for outpatient setting,$512.90 ,93% of total billed charges for outpatient setting,$93.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$93.83 ,101% Medicaid OPPS fee schedule for outpatient setting,$468.78 ,85% of total billed charges for outpatient setting,$496.35 ,90% of total billed charges for outpatient setting,$496.35 ,90% of total billed charges for outpatient setting,$92.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$479.81 ,87% of total billed charges for outpatient setting,$92.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$111.84 ,pay at 100% of APC for outpatient setting,$386.05 ,70% of total billed charges for outpatient setting,$92.90 ,$512.90 ,$441.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,58571,Hysterectomy Total Laparoscopic,360,"$47,725.00 ","$1,960.47 ",100% KS Medicaid OPPS fee schedule for outpatient setting,"$6,857.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,886.57 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$33,407.50 ",70% of total billed charges for outpatient setting,"$42,952.50 ",90% of total billed charges for outpatient setting,"$44,384.25 ",93% of total billed charges for outpatient setting,"$1,980.07 ",101% Medicaid OPPS fee schedule for outpatient setting,"$1,980.07 ",101% Medicaid OPPS fee schedule for outpatient setting,"$40,566.25 ",85% of total billed charges for outpatient setting,"$35,793.75 ",90% of total billed charges for outpatient setting,"$42,952.50 ",90% of total billed charges for outpatient setting,"$1,960.47 ",100% Medicaid OPPS fee schedule for outpatient setting,"$41,520.75 ",87% of total billed charges for outpatient setting,"$1,960.47 ",100% Medicaid OPPS fee schedule for outpatient setting,"$8,126.03 ",pay at 100% of APC for outpatient setting,"$33,407.50 ",70% of total billed charges for outpatient setting,"$1,886.57 ","$44,384.25 ","$38,180.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,10061,Incision and Drainage abscess complex,761,$669.50 ,$254.14 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,470.00 ",100% of BCBS Fee schedule for outpatient setting,$379.48 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$468.65 ,70% of total billed charges for outpatient setting,$602.55 ,90% of total billed charges for outpatient setting,$622.64 ,93% of total billed charges for outpatient setting,$256.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$256.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$569.08 ,85% of total billed charges for outpatient setting,$502.13 ,90% of total billed charges for outpatient setting,$602.55 ,90% of total billed charges for outpatient setting,$254.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$582.47 ,87% of total billed charges for outpatient setting,$254.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$333.60 ,pay at 100% of APC for outpatient setting,$468.65 ,70% of total billed charges for outpatient setting,$254.14 ,"$1,470.00 ",$535.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,10060,Incision and Drainage abscess simple,761,$630.00 ,$254.14 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$785.00 ,100% of BCBS Fee schedule for outpatient setting,$217.34 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$441.00 ,70% of total billed charges for outpatient setting,$567.00 ,90% of total billed charges for outpatient setting,$585.90 ,93% of total billed charges for outpatient setting,$256.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$256.68 ,101% Medicaid OPPS fee schedule for outpatient setting,$535.50 ,85% of total billed charges for outpatient setting,$472.50 ,90% of total billed charges for outpatient setting,$567.00 ,90% of total billed charges for outpatient setting,$254.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$548.10 ,87% of total billed charges for outpatient setting,$254.14 ,100% Medicaid OPPS fee schedule for outpatient setting,$161.47 ,pay at 100% of APC for outpatient setting,$441.00 ,70% of total billed charges for outpatient setting,$161.47 ,$785.00 ,$504.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96372,Injection Antibiotic or other medication,761,$191.50 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$29.88 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$134.05 ,70% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$178.10 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$162.78 ,85% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$172.35 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$166.61 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$60.33 ,pay at 100% of APC for outpatient setting,$134.05 ,70% of total billed charges for outpatient setting,$21.17 ,$178.10 ,$153.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,36556,Insert Centeral Vein Catheter,761,"$25,666.90 ",$480.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$2,640.00 ",100% of BCBS Fee schedule for outpatient setting,$175.45 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$17,966.83 ",70% of total billed charges for outpatient setting,"$23,100.21 ",90% of total billed charges for outpatient setting,"$23,870.22 ",93% of total billed charges for outpatient setting,$485.62 ,101% Medicaid OPPS fee schedule for outpatient setting,$485.62 ,101% Medicaid OPPS fee schedule for outpatient setting,"$21,816.87 ",85% of total billed charges for outpatient setting,"$19,250.18 ",90% of total billed charges for outpatient setting,"$23,100.21 ",90% of total billed charges for outpatient setting,$480.81 ,100% Medicaid OPPS fee schedule for outpatient setting,"$22,330.20 ",87% of total billed charges for outpatient setting,$480.81 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,663.85 ",pay at 100% of APC for outpatient setting,"$17,966.83 ",70% of total billed charges for outpatient setting,$175.45 ,"$23,870.22 ","$20,533.52 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96360,IV Hydration 1st hour,761,$460.50 ,$62.66 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$70.31 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$428.27 ,93% of total billed charges for outpatient setting,$63.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$63.29 ,101% Medicaid OPPS fee schedule for outpatient setting,$391.43 ,85% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$62.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$400.64 ,87% of total billed charges for outpatient setting,$62.66 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$62.66 ,$428.27 ,$368.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96361,IV Hydration each additional hour,761,$185.00 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$26.55 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$21.17 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96375,IV Push each additional Medication,761,$173.50 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$32.85 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$121.45 ,70% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$161.36 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$147.48 ,85% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$156.15 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$150.95 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$121.45 ,70% of total billed charges for outpatient setting,$30.72 ,$161.36 ,$138.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96374,IV Push Medication,761,$245.00 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,$80.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$171.50 ,70% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$227.85 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$208.25 ,85% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$220.50 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$213.15 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$171.50 ,70% of total billed charges for outpatient setting,$30.72 ,$227.85 ,$196.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96376,IV Push same drug >30 minutes,761,$188.50 ,$15.60 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$43.00 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$131.95 ,70% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$175.31 ,93% of total billed charges for outpatient setting,$15.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$15.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$160.23 ,85% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$169.65 ,90% of total billed charges for outpatient setting,$15.60 ,100% Medicaid OPPS fee schedule for outpatient setting,$164.00 ,87% of total billed charges for outpatient setting,$15.60 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$131.95 ,70% of total billed charges for outpatient setting,$15.60 ,$175.31 ,$150.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96365,IV Therapy 1st hour,761,$460.50 ,$109.37 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$138.36 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$428.27 ,93% of total billed charges for outpatient setting,$110.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$110.46 ,101% Medicaid OPPS fee schedule for outpatient setting,$391.43 ,85% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$414.45 ,90% of total billed charges for outpatient setting,$109.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$400.64 ,87% of total billed charges for outpatient setting,$109.37 ,100% Medicaid OPPS fee schedule for outpatient setting,$184.71 ,pay at 100% of APC for outpatient setting,$322.35 ,70% of total billed charges for outpatient setting,$109.37 ,$428.27 ,$368.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96366,IV Therapy each additional hour,761,$185.00 ,$21.17 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$43.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.38 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$21.17 ,100% Medicaid OPPS fee schedule for outpatient setting,$37.88 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$21.17 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96367,IV Therapy Sequential Drugs,761,$185.00 ,$30.72 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$132.00 ,100% of BCBS Fee schedule for outpatient setting,$62.15 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$172.05 ,93% of total billed charges for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$31.03 ,101% Medicaid OPPS fee schedule for outpatient setting,$157.25 ,85% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$166.50 ,90% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$160.95 ,87% of total billed charges for outpatient setting,$30.72 ,100% Medicaid OPPS fee schedule for outpatient setting,$60.33 ,pay at 100% of APC for outpatient setting,$129.50 ,70% of total billed charges for outpatient setting,$30.72 ,$172.05 ,$148.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,96368,IV Therapy Simultaneous Drugs,761,$91.50 ,N/A,Not separately reimbursable per CMS guidelines,$1.00 ,Not separately reimbursable per CMS guidelines,$42.31 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$64.05 ,70% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,$85.10 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$77.78 ,85% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,$82.35 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$79.61 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$64.05 ,70% of total billed charges for outpatient setting,$1.00 ,$85.10 ,$73.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,27447,Knee Arthroplasty,360,"$71,209.00 ",$896.05 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$7,866.00 ",100% of BCBS Fee schedule for outpatient setting,"$2,625.77 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$49,846.30 ",70% of total billed charges for outpatient setting,"$64,088.10 ",90% of total billed charges for outpatient setting,"$66,224.37 ",93% of total billed charges for outpatient setting,$905.01 ,101% Medicaid OPPS fee schedule for outpatient setting,$905.01 ,101% Medicaid OPPS fee schedule for outpatient setting,"$60,527.65 ",85% of total billed charges for outpatient setting,"$53,406.75 ",90% of total billed charges for outpatient setting,"$64,088.10 ",90% of total billed charges for outpatient setting,$896.05 ,100% Medicaid OPPS fee schedule for outpatient setting,"$61,951.83 ",87% of total billed charges for outpatient setting,$896.05 ,100% Medicaid OPPS fee schedule for outpatient setting,"$11,667.85 ",pay at 100% of APC for outpatient setting,"$49,846.30 ",70% of total billed charges for outpatient setting,$896.05 ,"$66,224.37 ","$56,967.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,29888,Knee Arthroscopy,360,"$46,519.00 ",$588.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$8,327.00 ",100% of BCBS Fee schedule for outpatient setting,"$2,008.29 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$32,563.30 ",70% of total billed charges for outpatient setting,"$41,867.10 ",90% of total billed charges for outpatient setting,"$43,262.67 ",93% of total billed charges for outpatient setting,$594.63 ,101% Medicaid OPPS fee schedule for outpatient setting,$594.63 ,101% Medicaid OPPS fee schedule for outpatient setting,"$39,541.15 ",85% of total billed charges for outpatient setting,"$34,889.25 ",90% of total billed charges for outpatient setting,"$41,867.10 ",90% of total billed charges for outpatient setting,$588.74 ,100% Medicaid OPPS fee schedule for outpatient setting,"$40,471.53 ",87% of total billed charges for outpatient setting,$588.74 ,100% Medicaid OPPS fee schedule for outpatient setting,"$5,914.93 ",pay at 100% of APC for outpatient setting,"$32,563.30 ",70% of total billed charges for outpatient setting,$588.74 ,"$43,262.67 ","$37,215.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59025,OB Non-stress Test,732,$523.50 ,$20.93 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$100.00 ,100% of BCBS Fee schedule for outpatient setting,$97.75 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$366.45 ,70% of total billed charges for outpatient setting,$471.15 ,90% of total billed charges for outpatient setting,$486.86 ,93% of total billed charges for outpatient setting,$21.14 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.14 ,101% Medicaid OPPS fee schedule for outpatient setting,$444.98 ,85% of total billed charges for outpatient setting,$392.63 ,90% of total billed charges for outpatient setting,$471.15 ,90% of total billed charges for outpatient setting,$20.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$455.45 ,87% of total billed charges for outpatient setting,$20.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$159.28 ,pay at 100% of APC for outpatient setting,$366.45 ,70% of total billed charges for outpatient setting,$20.93 ,$486.86 ,$418.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,99212,Outpatient visit Level 2,761,$294.00 ,N/A,Not separately reimbursable per CMS guidelines,$52.00 ,Not separately reimbursable per CMS guidelines,$75.77 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$205.80 ,70% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,$273.42 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$249.90 ,85% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$255.78 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$205.80 ,70% of total billed charges for outpatient setting,$52.00 ,$273.42 ,$235.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,99213,Outpatient visit Level 3,761,$294.00 ,N/A,Not separately reimbursable per CMS guidelines,$67.00 ,Not separately reimbursable per CMS guidelines,$140.47 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$205.80 ,70% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,$273.42 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$249.90 ,85% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,$264.60 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$255.78 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$205.80 ,70% of total billed charges for outpatient setting,$67.00 ,$273.42 ,$235.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,99214,Outpatient visit Level 4,761,$370.00 ,N/A,Not separately reimbursable per CMS guidelines,$80.00 ,Not separately reimbursable per CMS guidelines,$207.04 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$259.00 ,70% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,$344.10 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$314.50 ,85% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,$333.00 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$321.90 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$259.00 ,70% of total billed charges for outpatient setting,$80.00 ,$344.10 ,$296.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,99215,Outpatient visit Level 5,761,$470.00 ,N/A,Not separately reimbursable per CMS guidelines,$100.00 ,Not separately reimbursable per CMS guidelines,$306.20 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$329.00 ,70% of total billed charges for outpatient setting,$423.00 ,90% of total billed charges for outpatient setting,$437.10 ,93% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$399.50 ,85% of total billed charges for outpatient setting,$423.00 ,90% of total billed charges for outpatient setting,$423.00 ,90% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$408.90 ,87% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$329.00 ,70% of total billed charges for outpatient setting,$100.00 ,$437.10 ,$376.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,44970,Appendix Removal Laparoscopic,360,"$42,848.20 ",$654.16 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$5,398.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,232.07 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$29,993.74 ",70% of total billed charges for outpatient setting,"$38,563.38 ",90% of total billed charges for outpatient setting,"$39,848.83 ",93% of total billed charges for outpatient setting,$660.70 ,101% Medicaid OPPS fee schedule for outpatient setting,$660.70 ,101% Medicaid OPPS fee schedule for outpatient setting,"$36,420.97 ",85% of total billed charges for outpatient setting,"$32,136.15 ",90% of total billed charges for outpatient setting,"$38,563.38 ",90% of total billed charges for outpatient setting,$654.16 ,100% Medicaid OPPS fee schedule for outpatient setting,"$37,277.93 ",87% of total billed charges for outpatient setting,$654.16 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,660.80 ",pay at 100% of APC for outpatient setting,"$29,993.74 ",70% of total billed charges for outpatient setting,$654.16 ,"$39,848.83 ","$34,278.56 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,36590,Remove Central Vein Catheter,761,"$10,643.36 ",$346.63 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,888.00 ",100% of BCBS Fee schedule for outpatient setting,$390.68 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$7,450.35 ",70% of total billed charges for outpatient setting,"$9,579.02 ",90% of total billed charges for outpatient setting,"$9,898.32 ",93% of total billed charges for outpatient setting,$350.10 ,101% Medicaid OPPS fee schedule for outpatient setting,$350.10 ,101% Medicaid OPPS fee schedule for outpatient setting,"$9,046.86 ",85% of total billed charges for outpatient setting,"$7,982.52 ",90% of total billed charges for outpatient setting,"$9,579.02 ",90% of total billed charges for outpatient setting,$346.63 ,100% Medicaid OPPS fee schedule for outpatient setting,"$9,259.72 ",87% of total billed charges for outpatient setting,$346.63 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,330.46 ",pay at 100% of APC for outpatient setting,"$7,450.35 ",70% of total billed charges for outpatient setting,$346.63 ,"$9,898.32 ","$8,514.69 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,20680,Remove Deep Bone Implant,360,"$14,432.89 ",$327.08 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$2,788.00 ",100% of BCBS Fee schedule for outpatient setting,$862.62 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$10,103.02 ",70% of total billed charges for outpatient setting,"$12,989.60 ",90% of total billed charges for outpatient setting,"$13,422.59 ",93% of total billed charges for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,$330.35 ,101% Medicaid OPPS fee schedule for outpatient setting,"$12,267.96 ",85% of total billed charges for outpatient setting,"$10,824.67 ",90% of total billed charges for outpatient setting,"$12,989.60 ",90% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$12,556.61 ",87% of total billed charges for outpatient setting,$327.08 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,309.99 ",pay at 100% of APC for outpatient setting,"$10,103.02 ",70% of total billed charges for outpatient setting,$327.08 ,"$13,422.59 ","$11,546.31 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Gallbladder Removal Laparoscopic,360,"$26,657.04 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$4,826.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,349.90 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$18,659.93 ",70% of total billed charges for outpatient setting,"$23,991.34 ",90% of total billed charges for outpatient setting,"$24,791.05 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$22,658.48 ",85% of total billed charges for outpatient setting,"$3,771.52 ",Case Rate,"$23,991.34 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$23,191.62 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,660.80 ",pay at 100% of APC for outpatient setting,"$18,659.93 ",70% of total billed charges for outpatient setting,$569.12 ,"$24,791.05 ","$21,325.63 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,58662,Remove Lesions Ovary/Pelvic Laparoscopic,360,"$26,789.28 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$5,011.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,478.31 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$18,752.50 ",70% of total billed charges for outpatient setting,"$24,110.35 ",90% of total billed charges for outpatient setting,"$24,914.03 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$22,770.89 ",85% of total billed charges for outpatient setting,"$20,091.96 ",90% of total billed charges for outpatient setting,"$24,110.35 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$23,306.67 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,660.80 ",pay at 100% of APC for outpatient setting,"$18,752.50 ",70% of total billed charges for outpatient setting,$569.12 ,"$24,914.03 ","$21,431.42 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,57288,Repair Bladder Incontinence,360,"$25,715.00 ","$2,896.08 ",100% KS Medicaid OPPS fee schedule for outpatient setting,"$6,516.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,550.34 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$18,000.50 ",70% of total billed charges for outpatient setting,"$23,143.50 ",90% of total billed charges for outpatient setting,"$23,914.95 ",93% of total billed charges for outpatient setting,"$2,925.04 ",101% Medicaid OPPS fee schedule for outpatient setting,"$2,925.04 ",101% Medicaid OPPS fee schedule for outpatient setting,"$21,857.75 ",85% of total billed charges for outpatient setting,"$19,286.25 ",90% of total billed charges for outpatient setting,"$23,143.50 ",90% of total billed charges for outpatient setting,"$2,896.08 ",100% Medicaid OPPS fee schedule for outpatient setting,"$22,372.05 ",87% of total billed charges for outpatient setting,"$2,896.08 ",100% Medicaid OPPS fee schedule for outpatient setting,"$4,144.79 ",pay at 100% of APC for outpatient setting,"$18,000.50 ",70% of total billed charges for outpatient setting,"$1,550.34 ","$23,914.95 ","$20,572.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shoulder Arthroscopy,360,"$47,949.00 ",$981.24 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$3,807.00 ",100% of BCBS Fee schedule for outpatient setting,$353.01 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$33,564.30 ",70% of total billed charges for outpatient setting,"$43,154.10 ",90% of total billed charges for outpatient setting,"$44,592.57 ",93% of total billed charges for outpatient setting,$991.05 ,101% Medicaid OPPS fee schedule for outpatient setting,$991.05 ,101% Medicaid OPPS fee schedule for outpatient setting,"$40,756.65 ",85% of total billed charges for outpatient setting,"$35,961.75 ",90% of total billed charges for outpatient setting,"$43,154.10 ",90% of total billed charges for outpatient setting,$981.24 ,100% Medicaid OPPS fee schedule for outpatient setting,"$41,715.63 ",87% of total billed charges for outpatient setting,$981.24 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$33,564.30 ",70% of total billed charges for outpatient setting,$353.01 ,"$44,592.57 ","$38,359.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,29827,Shoulder Arthroscopy with Rotator Cuff Repair,360,"$47,949.00 ",$588.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$5,804.00 ",100% of BCBS Fee schedule for outpatient setting,"$2,196.44 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$33,564.30 ",70% of total billed charges for outpatient setting,"$43,154.10 ",90% of total billed charges for outpatient setting,"$44,592.57 ",93% of total billed charges for outpatient setting,$594.63 ,101% Medicaid OPPS fee schedule for outpatient setting,$594.63 ,101% Medicaid OPPS fee schedule for outpatient setting,"$40,756.65 ",85% of total billed charges for outpatient setting,"$35,961.75 ",90% of total billed charges for outpatient setting,"$43,154.10 ",90% of total billed charges for outpatient setting,$588.74 ,100% Medicaid OPPS fee schedule for outpatient setting,"$41,715.63 ",87% of total billed charges for outpatient setting,$588.74 ,100% Medicaid OPPS fee schedule for outpatient setting,"$5,914.93 ",pay at 100% of APC for outpatient setting,"$33,564.30 ",70% of total billed charges for outpatient setting,$588.74 ,"$44,592.57 ","$38,359.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,15273,Skin Graft Trunk/Extremity < 100sqcm,761,"$3,920.00 ",$295.63 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$2,447.00 ",100% of BCBS Fee schedule for outpatient setting,$404.56 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,744.00 ",70% of total billed charges for outpatient setting,"$3,528.00 ",90% of total billed charges for outpatient setting,"$3,645.60 ",93% of total billed charges for outpatient setting,$298.59 ,101% Medicaid OPPS fee schedule for outpatient setting,$298.59 ,101% Medicaid OPPS fee schedule for outpatient setting,"$3,332.00 ",85% of total billed charges for outpatient setting,"$2,940.00 ",90% of total billed charges for outpatient setting,"$3,528.00 ",90% of total billed charges for outpatient setting,$295.63 ,100% Medicaid OPPS fee schedule for outpatient setting,"$3,410.40 ",87% of total billed charges for outpatient setting,$295.63 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,908.93 ",pay at 100% of APC for outpatient setting,"$2,744.00 ",70% of total billed charges for outpatient setting,$295.63 ,"$3,645.60 ","$3,136.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59120,Treat Ectopic Pregnancy,360,"$21,580.00 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$5,460.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,645.60 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$15,106.00 ",70% of total billed charges for outpatient setting,"$19,422.00 ",90% of total billed charges for outpatient setting,"$20,069.40 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$18,343.00 ",85% of total billed charges for outpatient setting,"$16,185.00 ",90% of total billed charges for outpatient setting,"$19,422.00 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$18,774.60 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$21,580.00 ",pay at 100% of APC for outpatient setting,"$15,106.00 ",70% of total billed charges for outpatient setting,$569.12 ,"$21,580.00 ","$17,264.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59151,Treat Ectopic Pregnancy with removal tubes/ovary,360,"$34,463.03 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$6,057.00 ",100% of BCBS Fee schedule for outpatient setting,"$1,563.17 ",220% CMS Medicare Physician fee  schedule for outpatient setting,"$24,124.12 ",70% of total billed charges for outpatient setting,"$31,016.73 ",90% of total billed charges for outpatient setting,"$32,050.62 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$29,293.58 ",85% of total billed charges for outpatient setting,"$25,847.27 ",90% of total billed charges for outpatient setting,"$31,016.73 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$29,982.84 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,660.80 ",pay at 100% of APC for outpatient setting,"$24,124.12 ",70% of total billed charges for outpatient setting,$569.12 ,"$32,050.62 ","$27,570.42 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59820,Treat Miscarriage,360,"$12,235.00 ",$523.33 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,912.00 ",100% of BCBS Fee schedule for outpatient setting,$781.59 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$8,564.50 ",70% of total billed charges for outpatient setting,"$11,011.50 ",90% of total billed charges for outpatient setting,"$11,378.55 ",93% of total billed charges for outpatient setting,$528.56 ,101% Medicaid OPPS fee schedule for outpatient setting,$528.56 ,101% Medicaid OPPS fee schedule for outpatient setting,"$10,399.75 ",85% of total billed charges for outpatient setting,"$9,176.25 ",90% of total billed charges for outpatient setting,"$11,011.50 ",90% of total billed charges for outpatient setting,$523.33 ,100% Medicaid OPPS fee schedule for outpatient setting,"$10,644.45 ",87% of total billed charges for outpatient setting,$523.33 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,528.35 ",pay at 100% of APC for outpatient setting,"$8,564.50 ",70% of total billed charges for outpatient setting,$523.33 ,"$11,378.55 ","$9,788.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,58671,Tubal - Sterilization Female,360,"$18,437.51 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$4,744.00 ",100% of BCBS Fee schedule for outpatient setting,$773.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$12,906.26 ",70% of total billed charges for outpatient setting,"$16,593.76 ",90% of total billed charges for outpatient setting,"$17,146.88 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$15,671.88 ",85% of total billed charges for outpatient setting,"$13,828.13 ",90% of total billed charges for outpatient setting,"$16,593.76 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$16,040.63 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,660.80 ",pay at 100% of APC for outpatient setting,"$12,906.26 ",70% of total billed charges for outpatient setting,$569.12 ,"$17,146.88 ","$14,750.01 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,55250,Vasectomy - Sterilization Male,360,"$18,027.00 ",$569.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,"$1,321.00 ",100% of BCBS Fee schedule for outpatient setting,$473.07 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$12,618.90 ",70% of total billed charges for outpatient setting,"$16,224.30 ",90% of total billed charges for outpatient setting,"$16,765.11 ",93% of total billed charges for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,$574.81 ,101% Medicaid OPPS fee schedule for outpatient setting,"$15,322.95 ",85% of total billed charges for outpatient setting,"$13,520.25 ",90% of total billed charges for outpatient setting,"$16,224.30 ",90% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$15,683.49 ",87% of total billed charges for outpatient setting,$569.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,658.67 ",pay at 100% of APC for outpatient setting,"$12,618.90 ",70% of total billed charges for outpatient setting,$473.07 ,"$16,765.11 ","$14,421.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97014,Electrical Stimulation,420,$58.50 ,$16.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$31.00 ,100% of BCBS Fee schedule for outpatient setting,$26.49 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$40.95 ,70% of total billed charges for outpatient setting,$52.65 ,90% of total billed charges for outpatient setting,$54.41 ,93% of total billed charges for outpatient setting,$17.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$49.73 ,85% of total billed charges for outpatient setting,$52.65 ,90% of total billed charges for outpatient setting,$52.65 ,90% of total billed charges for outpatient setting,$16.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$50.90 ,87% of total billed charges for outpatient setting,$16.87 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$40.95 ,70% of total billed charges for outpatient setting,$16.87 ,$54.41 ,$46.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97018,Parafin Bath Therapy,420,$54.00 ,$15.96 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$23.00 ,100% of BCBS Fee schedule for outpatient setting,$11.81 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$37.80 ,70% of total billed charges for outpatient setting,$48.60 ,90% of total billed charges for outpatient setting,$50.22 ,93% of total billed charges for outpatient setting,$16.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$16.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$45.90 ,85% of total billed charges for outpatient setting,$48.60 ,90% of total billed charges for outpatient setting,$48.60 ,90% of total billed charges for outpatient setting,$15.96 ,100% Medicaid OPPS fee schedule for outpatient setting,$46.98 ,87% of total billed charges for outpatient setting,$15.96 ,100% Medicaid OPPS fee schedule for outpatient setting,$5.27 ,100% CMS Medicare physician fee schedule for outpatient setting,$37.80 ,70% of total billed charges for outpatient setting,$5.27 ,$50.22 ,$43.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97110,Initial Strengthening Exercise 15 min,420,$130.50 ,$25.65 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$49.00 ,100% of BCBS Fee schedule for outpatient setting,$62.59 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$91.35 ,70% of total billed charges for outpatient setting,$117.45 ,90% of total billed charges for outpatient setting,$121.37 ,93% of total billed charges for outpatient setting,$25.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$25.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$110.93 ,85% of total billed charges for outpatient setting,$117.45 ,90% of total billed charges for outpatient setting,$117.45 ,90% of total billed charges for outpatient setting,$25.65 ,100% Medicaid OPPS fee schedule for outpatient setting,$113.54 ,87% of total billed charges for outpatient setting,$25.65 ,100% Medicaid OPPS fee schedule for outpatient setting,$28.32 ,100% CMS Medicare physician fee schedule for outpatient setting,$91.35 ,70% of total billed charges for outpatient setting,$25.65 ,$121.37 ,$104.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97112,Neuro Muscle Education,420,$84.00 ,$24.87 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$50.00 ,100% of BCBS Fee schedule for outpatient setting,$72.62 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$58.80 ,70% of total billed charges for outpatient setting,$75.60 ,90% of total billed charges for outpatient setting,$78.12 ,93% of total billed charges for outpatient setting,$25.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$25.12 ,101% Medicaid OPPS fee schedule for outpatient setting,$71.40 ,85% of total billed charges for outpatient setting,$75.60 ,90% of total billed charges for outpatient setting,$75.60 ,90% of total billed charges for outpatient setting,$24.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$73.08 ,87% of total billed charges for outpatient setting,$24.87 ,100% Medicaid OPPS fee schedule for outpatient setting,$32.48 ,100% CMS Medicare physician fee schedule for outpatient setting,$58.80 ,70% of total billed charges for outpatient setting,$24.87 ,$78.12 ,$67.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97116,Gait Training 15 min,420,$65.00 ,$22.18 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$46.00 ,100% of BCBS Fee schedule for outpatient setting,$62.59 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$45.50 ,70% of total billed charges for outpatient setting,$58.50 ,90% of total billed charges for outpatient setting,$60.45 ,93% of total billed charges for outpatient setting,$22.40 ,101% Medicaid OPPS fee schedule for outpatient setting,$22.40 ,101% Medicaid OPPS fee schedule for outpatient setting,$55.25 ,85% of total billed charges for outpatient setting,$58.50 ,90% of total billed charges for outpatient setting,$58.50 ,90% of total billed charges for outpatient setting,$22.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$56.55 ,87% of total billed charges for outpatient setting,$22.18 ,100% Medicaid OPPS fee schedule for outpatient setting,$28.32 ,100% CMS Medicare physician fee schedule for outpatient setting,$45.50 ,70% of total billed charges for outpatient setting,$22.18 ,$62.59 ,$52.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97140,Manual Therapy 15 min,420,$98.00 ,$20.47 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$50.00 ,100% of BCBS Fee schedule for outpatient setting,$57.62 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$68.60 ,70% of total billed charges for outpatient setting,$88.20 ,90% of total billed charges for outpatient setting,$91.14 ,93% of total billed charges for outpatient setting,$20.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$20.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$83.30 ,85% of total billed charges for outpatient setting,$88.20 ,90% of total billed charges for outpatient setting,$88.20 ,90% of total billed charges for outpatient setting,$20.47 ,100% Medicaid OPPS fee schedule for outpatient setting,$85.26 ,87% of total billed charges for outpatient setting,$20.47 ,100% Medicaid OPPS fee schedule for outpatient setting,$26.11 ,100% CMS Medicare physician fee schedule for outpatient setting,$68.60 ,70% of total billed charges for outpatient setting,$20.47 ,$91.14 ,$78.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97530,Theraputic Activity 15 min,420,$88.00 ,$26.02 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$49.00 ,100% of BCBS Fee schedule for outpatient setting,$78.43 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$61.60 ,70% of total billed charges for outpatient setting,$79.20 ,90% of total billed charges for outpatient setting,$81.84 ,93% of total billed charges for outpatient setting,$26.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$26.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$74.80 ,85% of total billed charges for outpatient setting,$79.20 ,90% of total billed charges for outpatient setting,$79.20 ,90% of total billed charges for outpatient setting,$26.02 ,100% Medicaid OPPS fee schedule for outpatient setting,$76.56 ,87% of total billed charges for outpatient setting,$26.02 ,100% Medicaid OPPS fee schedule for outpatient setting,$35.36 ,100% CMS Medicare physician fee schedule for outpatient setting,$61.60 ,70% of total billed charges for outpatient setting,$26.02 ,$81.84 ,$70.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97035,Physical Therapy Ultrasound 15 min,420,$71.50 ,$14.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$29.00 ,100% of BCBS Fee schedule for outpatient setting,$30.16 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$50.05 ,70% of total billed charges for outpatient setting,$64.35 ,90% of total billed charges for outpatient setting,$66.50 ,93% of total billed charges for outpatient setting,$14.24 ,101% Medicaid OPPS fee schedule for outpatient setting,$14.24 ,101% Medicaid OPPS fee schedule for outpatient setting,$60.78 ,85% of total billed charges for outpatient setting,$64.35 ,90% of total billed charges for outpatient setting,$64.35 ,90% of total billed charges for outpatient setting,$14.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$62.21 ,87% of total billed charges for outpatient setting,$14.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.73 ,100% CMS Medicare physician fee schedule for outpatient setting,$50.05 ,70% of total billed charges for outpatient setting,$13.73 ,$66.50 ,$57.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97012,Physical Therapy Pelvic/Cervical Traction,420,$68.50 ,$16.89 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$36.00 ,100% of BCBS Fee schedule for outpatient setting,$30.43 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$47.95 ,70% of total billed charges for outpatient setting,$61.65 ,90% of total billed charges for outpatient setting,$63.71 ,93% of total billed charges for outpatient setting,$17.06 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.06 ,101% Medicaid OPPS fee schedule for outpatient setting,$58.23 ,85% of total billed charges for outpatient setting,$61.65 ,90% of total billed charges for outpatient setting,$61.65 ,90% of total billed charges for outpatient setting,$16.89 ,100% Medicaid OPPS fee schedule for outpatient setting,$59.60 ,87% of total billed charges for outpatient setting,$16.89 ,100% Medicaid OPPS fee schedule for outpatient setting,$13.86 ,100% CMS Medicare physician fee schedule for outpatient setting,$47.95 ,70% of total billed charges for outpatient setting,$13.86 ,$63.71 ,$54.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97161,Physical Therapy Eval Low,424,$170.00 ,$65.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$119.41 ,100% of BCBS Fee schedule for outpatient setting,$213.00 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$153.00 ,90% of total billed charges for outpatient setting,$158.10 ,93% of total billed charges for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$153.00 ,90% of total billed charges for outpatient setting,$153.00 ,90% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$147.90 ,87% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$96.50 ,100% CMS Medicare physician fee schedule for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$65.71 ,$213.00 ,$136.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97162,Physical Therapy Eval Moderate,424,$214.00 ,$65.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$119.41 ,100% of BCBS Fee schedule for outpatient setting,$213.00 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$199.02 ,93% of total billed charges for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$186.18 ,87% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$96.50 ,100% CMS Medicare physician fee schedule for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$65.71 ,$213.00 ,$171.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97163,Physical Therapy Eval High Complex,424,$268.00 ,$65.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$119.41 ,100% of BCBS Fee schedule for outpatient setting,$213.00 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$187.60 ,70% of total billed charges for outpatient setting,$241.20 ,90% of total billed charges for outpatient setting,$249.24 ,93% of total billed charges for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$66.37 ,101% Medicaid OPPS fee schedule for outpatient setting,$227.80 ,85% of total billed charges for outpatient setting,$241.20 ,90% of total billed charges for outpatient setting,$241.20 ,90% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$233.16 ,87% of total billed charges for outpatient setting,$65.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$96.50 ,100% CMS Medicare physician fee schedule for outpatient setting,$187.60 ,70% of total billed charges for outpatient setting,$65.71 ,$249.24 ,$214.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,Physical Therapy,97164,Physical Therapy Re-Eval,424,$118.50 ,$35.34 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$80.53 ,100% of BCBS Fee schedule for outpatient setting,$146.37 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$82.95 ,70% of total billed charges for outpatient setting,$106.65 ,90% of total billed charges for outpatient setting,$110.21 ,93% of total billed charges for outpatient setting,$35.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$35.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$100.73 ,85% of total billed charges for outpatient setting,$106.65 ,90% of total billed charges for outpatient setting,$106.65 ,90% of total billed charges for outpatient setting,$35.34 ,100% Medicaid OPPS fee schedule for outpatient setting,$103.10 ,87% of total billed charges for outpatient setting,$35.34 ,100% Medicaid OPPS fee schedule for outpatient setting,$66.40 ,100% CMS Medicare physician fee schedule for outpatient setting,$82.95 ,70% of total billed charges for outpatient setting,$35.34 ,$146.37 ,$94.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,70030,Xray Orbits/Eyes,320,$379.00 ,$11.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$82.80 ,100% of BCBS Fee schedule for outpatient setting,$67.63 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$265.30 ,70% of total billed charges for outpatient setting,$341.10 ,90% of total billed charges for outpatient setting,$352.47 ,93% of total billed charges for outpatient setting,$11.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$322.15 ,85% of total billed charges for outpatient setting,$341.10 ,90% of total billed charges for outpatient setting,$341.10 ,90% of total billed charges for outpatient setting,$11.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$329.73 ,87% of total billed charges for outpatient setting,$11.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$265.30 ,70% of total billed charges for outpatient setting,$11.12 ,$352.47 ,$303.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,70450,CT Head w/o contrast,351,"$2,409.50 ",$123.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$230.27 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,686.65 ",70% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,"$2,240.84 ",93% of total billed charges for outpatient setting,$124.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$124.33 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,048.08 ",85% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,$123.10 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,096.27 ",87% of total billed charges for outpatient setting,$123.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,686.65 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,240.84 ","$1,927.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,70486,CT Sinus/Facial Bones w/o Contrast,351,"$1,756.50 ",$133.01 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$277.99 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,229.55 ",70% of total billed charges for outpatient setting,"$1,580.85 ",90% of total billed charges for outpatient setting,"$1,633.55 ",93% of total billed charges for outpatient setting,$134.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$134.34 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,493.03 ",85% of total billed charges for outpatient setting,"$1,580.85 ",90% of total billed charges for outpatient setting,"$1,580.85 ",90% of total billed charges for outpatient setting,$133.01 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,528.16 ",87% of total billed charges for outpatient setting,$133.01 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,229.55 ",70% of total billed charges for outpatient setting,$95.57 ,"$1,633.55 ","$1,405.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,70553,MRI Head with & w/o Contrast,611,"$4,784.00 ","$1,054.61 ",100% KS Medicaid OPPS fee schedule for outpatient setting,$521.00 ,100% of BCBS Fee schedule for outpatient setting,$702.88 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$3,348.80 ",70% of total billed charges for outpatient setting,"$4,305.60 ",90% of total billed charges for outpatient setting,"$4,449.12 ",93% of total billed charges for outpatient setting,"$1,065.16 ",101% Medicaid OPPS fee schedule for outpatient setting,"$1,065.16 ",101% Medicaid OPPS fee schedule for outpatient setting,"$4,066.40 ",85% of total billed charges for outpatient setting,"$4,305.60 ",90% of total billed charges for outpatient setting,"$4,305.60 ",90% of total billed charges for outpatient setting,"$1,054.61 ",100% Medicaid OPPS fee schedule for outpatient setting,"$4,162.08 ",87% of total billed charges for outpatient setting,"$1,054.61 ",100% Medicaid OPPS fee schedule for outpatient setting,$329.45 ,pay at 100% of APC for outpatient setting,"$3,348.80 ",70% of total billed charges for outpatient setting,$329.45 ,"$4,449.12 ","$3,827.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,71045,Xray Chest,324,$451.50 ,$6.57 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.36 ,100% of BCBS Fee schedule for outpatient setting,$53.79 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$316.05 ,70% of total billed charges for outpatient setting,$406.35 ,90% of total billed charges for outpatient setting,$419.90 ,93% of total billed charges for outpatient setting,$6.64 ,101% Medicaid OPPS fee schedule for outpatient setting,$6.64 ,101% Medicaid OPPS fee schedule for outpatient setting,$383.78 ,85% of total billed charges for outpatient setting,$406.35 ,90% of total billed charges for outpatient setting,$406.35 ,90% of total billed charges for outpatient setting,$6.57 ,100% Medicaid OPPS fee schedule for outpatient setting,$392.81 ,87% of total billed charges for outpatient setting,$6.57 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.69 ,pay at 100% of APC for outpatient setting,$316.05 ,70% of total billed charges for outpatient setting,$6.57 ,$419.90 ,$361.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,71046,Xray Chest 2 views,324,$577.50 ,$12.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$69.98 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$404.25 ,70% of total billed charges for outpatient setting,$519.75 ,90% of total billed charges for outpatient setting,$537.08 ,93% of total billed charges for outpatient setting,$12.24 ,101% Medicaid OPPS fee schedule for outpatient setting,$12.24 ,101% Medicaid OPPS fee schedule for outpatient setting,$490.88 ,85% of total billed charges for outpatient setting,$519.75 ,90% of total billed charges for outpatient setting,$519.75 ,90% of total billed charges for outpatient setting,$12.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$502.43 ,87% of total billed charges for outpatient setting,$12.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.69 ,pay at 100% of APC for outpatient setting,$404.25 ,70% of total billed charges for outpatient setting,$12.12 ,$537.08 ,$462.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,71250,CT Chest w/o Contrast,352,"$2,651.00 ",$236.33 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$289.63 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,855.70 ",70% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,"$2,465.43 ",93% of total billed charges for outpatient setting,$238.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$238.69 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,253.35 ",85% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,$236.33 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,306.37 ",87% of total billed charges for outpatient setting,$236.33 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,855.70 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,465.43 ","$2,120.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,71260,CT Chest with Contrast,352,"$3,172.36 ",$299.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$363.46 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,220.65 ",70% of total billed charges for outpatient setting,"$2,855.12 ",90% of total billed charges for outpatient setting,"$2,950.29 ",93% of total billed charges for outpatient setting,$302.74 ,101% Medicaid OPPS fee schedule for outpatient setting,$302.74 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,696.51 ",85% of total billed charges for outpatient setting,"$2,855.12 ",90% of total billed charges for outpatient setting,"$2,855.12 ",90% of total billed charges for outpatient setting,$299.74 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,759.95 ",87% of total billed charges for outpatient setting,$299.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$161.26 ,pay at 100% of APC for outpatient setting,"$2,220.65 ",70% of total billed charges for outpatient setting,$161.26 ,"$2,950.29 ","$2,537.89 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72040,Xray Cervical Spine,320,$457.50 ,$24.25 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$158.24 ,100% of BCBS Fee schedule for outpatient setting,$82.41 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$320.25 ,70% of total billed charges for outpatient setting,$411.75 ,90% of total billed charges for outpatient setting,$425.48 ,93% of total billed charges for outpatient setting,$24.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$24.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$388.88 ,85% of total billed charges for outpatient setting,$411.75 ,90% of total billed charges for outpatient setting,$411.75 ,90% of total billed charges for outpatient setting,$24.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$398.03 ,87% of total billed charges for outpatient setting,$24.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$320.25 ,70% of total billed charges for outpatient setting,$24.25 ,$425.48 ,$366.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72100,Xray Lumbar Spine,320,$565.00 ,$26.93 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$172.96 ,100% of BCBS Fee schedule for outpatient setting,$83.12 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$395.50 ,70% of total billed charges for outpatient setting,$508.50 ,90% of total billed charges for outpatient setting,$525.45 ,93% of total billed charges for outpatient setting,$27.20 ,101% Medicaid OPPS fee schedule for outpatient setting,$27.20 ,101% Medicaid OPPS fee schedule for outpatient setting,$480.25 ,85% of total billed charges for outpatient setting,$508.50 ,90% of total billed charges for outpatient setting,$508.50 ,90% of total billed charges for outpatient setting,$26.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$491.55 ,87% of total billed charges for outpatient setting,$26.93 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$395.50 ,70% of total billed charges for outpatient setting,$26.93 ,$525.45 ,$452.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72110,Xray Lumbar Spine Complete,320,$868.50 ,$36.76 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$245.64 ,100% of BCBS Fee schedule for outpatient setting,$106.90 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$807.71 ,93% of total billed charges for outpatient setting,$37.13 ,101% Medicaid OPPS fee schedule for outpatient setting,$37.13 ,101% Medicaid OPPS fee schedule for outpatient setting,$738.23 ,85% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$36.76 ,100% Medicaid OPPS fee schedule for outpatient setting,$755.60 ,87% of total billed charges for outpatient setting,$36.76 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$36.76 ,$807.71 ,$694.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72125,CT Cervical Spine w/o Contrast,352,"$2,409.50 ",$157.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$283.54 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,686.65 ",70% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,"$2,240.84 ",93% of total billed charges for outpatient setting,$158.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$158.69 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,048.08 ",85% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,"$2,168.55 ",90% of total billed charges for outpatient setting,$157.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,096.27 ",87% of total billed charges for outpatient setting,$157.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,686.65 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,240.84 ","$1,927.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72131,CT Lumbar Spine w/o Contrast,352,"$2,651.00 ",$157.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$282.15 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,855.70 ",70% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,"$2,465.43 ",93% of total billed charges for outpatient setting,$158.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$158.69 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,253.35 ",85% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,"$2,385.90 ",90% of total billed charges for outpatient setting,$157.12 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,306.37 ",87% of total billed charges for outpatient setting,$157.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,855.70 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,465.43 ","$2,120.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72141,MR Cervical Spine w/o Contrast,612,"$3,448.00 ",$474.59 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$521.00 ,100% of BCBS Fee schedule for outpatient setting,$421.01 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,413.60 ",70% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,"$3,206.64 ",93% of total billed charges for outpatient setting,$479.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$479.34 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,930.80 ",85% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,$474.59 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,999.76 ",87% of total billed charges for outpatient setting,$474.59 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,"$2,413.60 ",70% of total billed charges for outpatient setting,$208.81 ,"$3,206.64 ","$2,758.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72148,MRI Lumbar Spine w/o Contrast,612,"$3,448.00 ",$526.96 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$521.00 ,100% of BCBS Fee schedule for outpatient setting,$421.70 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,413.60 ",70% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,"$3,206.64 ",93% of total billed charges for outpatient setting,$532.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$532.23 ,101% Medicaid OPPS fee schedule for outpatient setting,"$2,930.80 ",85% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,"$3,103.20 ",90% of total billed charges for outpatient setting,$526.96 ,100% Medicaid OPPS fee schedule for outpatient setting,"$2,999.76 ",87% of total billed charges for outpatient setting,$526.96 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,"$2,413.60 ",70% of total billed charges for outpatient setting,$208.81 ,"$3,206.64 ","$2,758.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73000,Xray Clavicle Bilateral,320,$368.50 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$113.16 ,100% of BCBS Fee schedule for outpatient setting,$66.79 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$257.95 ,70% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$342.71 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$313.23 ,85% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$320.60 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$257.95 ,70% of total billed charges for outpatient setting,$21.07 ,$342.71 ,$294.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73030,Xray Shoulder,320,$468.50 ,$23.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$138.92 ,100% of BCBS Fee schedule for outpatient setting,$71.76 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$435.71 ,93% of total billed charges for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$398.23 ,85% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$407.60 ,87% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$23.10 ,$435.71 ,$374.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73070,Xray Elbow 2 views,320,$368.50 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$112.24 ,100% of BCBS Fee schedule for outpatient setting,$60.57 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$257.95 ,70% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$342.71 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$313.23 ,85% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$331.65 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$320.60 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$257.95 ,70% of total billed charges for outpatient setting,$21.07 ,$342.71 ,$294.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73080,Xray Elbow 3 or more views,320,$418.00 ,$23.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$149.96 ,100% of BCBS Fee schedule for outpatient setting,$67.54 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$292.60 ,70% of total billed charges for outpatient setting,$376.20 ,90% of total billed charges for outpatient setting,$388.74 ,93% of total billed charges for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$355.30 ,85% of total billed charges for outpatient setting,$376.20 ,90% of total billed charges for outpatient setting,$376.20 ,90% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$363.66 ,87% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$292.60 ,70% of total billed charges for outpatient setting,$23.10 ,$388.74 ,$334.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73090,Xray Forearm Bilateral,320,$872.50 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$123.28 ,100% of BCBS Fee schedule for outpatient setting,$60.57 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$610.75 ,70% of total billed charges for outpatient setting,$785.25 ,90% of total billed charges for outpatient setting,$811.43 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$741.63 ,85% of total billed charges for outpatient setting,$785.25 ,90% of total billed charges for outpatient setting,$785.25 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$759.08 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$610.75 ,70% of total billed charges for outpatient setting,$21.07 ,$811.43 ,$698.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73110,Xray Wrist,320,$499.50 ,$21.46 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$141.68 ,100% of BCBS Fee schedule for outpatient setting,$84.83 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$349.65 ,70% of total billed charges for outpatient setting,$449.55 ,90% of total billed charges for outpatient setting,$464.54 ,93% of total billed charges for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$424.58 ,85% of total billed charges for outpatient setting,$449.55 ,90% of total billed charges for outpatient setting,$449.55 ,90% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$434.57 ,87% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$349.65 ,70% of total billed charges for outpatient setting,$21.46 ,$464.54 ,$399.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73130,Xray Hand,320,$468.50 ,$21.46 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$135.24 ,100% of BCBS Fee schedule for outpatient setting,$75.86 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$435.71 ,93% of total billed charges for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$398.23 ,85% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$407.60 ,87% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$21.46 ,$435.71 ,$374.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73140,Xray Finger,320,$298.50 ,$16.83 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$104.88 ,100% of BCBS Fee schedule for outpatient setting,$77.64 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$208.95 ,70% of total billed charges for outpatient setting,$268.65 ,90% of total billed charges for outpatient setting,$277.61 ,93% of total billed charges for outpatient setting,$17.00 ,101% Medicaid OPPS fee schedule for outpatient setting,$17.00 ,101% Medicaid OPPS fee schedule for outpatient setting,$253.73 ,85% of total billed charges for outpatient setting,$268.65 ,90% of total billed charges for outpatient setting,$268.65 ,90% of total billed charges for outpatient setting,$16.83 ,100% Medicaid OPPS fee schedule for outpatient setting,$259.70 ,87% of total billed charges for outpatient setting,$16.83 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$208.95 ,70% of total billed charges for outpatient setting,$16.83 ,$277.61 ,$238.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73200,CT Upper Extremity w/o Contrast,320,"$2,165.50 ",$198.41 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$356.11 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,515.85 ",70% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,"$2,013.92 ",93% of total billed charges for outpatient setting,$200.39 ,101% Medicaid OPPS fee schedule for outpatient setting,$200.39 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,840.68 ",85% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,$198.41 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,883.99 ",87% of total billed charges for outpatient setting,$198.41 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,515.85 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,013.92 ","$1,732.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73221,MRI Upper Extremity w/o Contrast,610,"$3,755.50 ",$253.61 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$521.00 ,100% of BCBS Fee schedule for outpatient setting,$444.29 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,628.85 ",70% of total billed charges for outpatient setting,"$3,379.95 ",90% of total billed charges for outpatient setting,"$3,492.62 ",93% of total billed charges for outpatient setting,$256.15 ,101% Medicaid OPPS fee schedule for outpatient setting,$256.15 ,101% Medicaid OPPS fee schedule for outpatient setting,"$3,192.18 ",85% of total billed charges for outpatient setting,"$3,379.95 ",90% of total billed charges for outpatient setting,"$3,379.95 ",90% of total billed charges for outpatient setting,$253.61 ,100% Medicaid OPPS fee schedule for outpatient setting,"$3,267.29 ",87% of total billed charges for outpatient setting,$253.61 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,"$2,628.85 ",70% of total billed charges for outpatient setting,$208.81 ,"$3,492.62 ","$3,004.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73502,Xray Hip and Pelvis 3 views,320,$468.50 ,$51.70 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.64 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$435.71 ,93% of total billed charges for outpatient setting,$52.22 ,101% Medicaid OPPS fee schedule for outpatient setting,$52.22 ,101% Medicaid OPPS fee schedule for outpatient setting,$398.23 ,85% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$421.65 ,90% of total billed charges for outpatient setting,$51.70 ,100% Medicaid OPPS fee schedule for outpatient setting,$407.60 ,87% of total billed charges for outpatient setting,$51.70 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$327.95 ,70% of total billed charges for outpatient setting,$51.70 ,$435.71 ,$374.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73503,Xray hip and Pelvis 4 or more views,320,$618.50 ,$85.63 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$122.87 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$432.95 ,70% of total billed charges for outpatient setting,$556.65 ,90% of total billed charges for outpatient setting,$575.21 ,93% of total billed charges for outpatient setting,$86.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$86.49 ,101% Medicaid OPPS fee schedule for outpatient setting,$525.73 ,85% of total billed charges for outpatient setting,$556.65 ,90% of total billed charges for outpatient setting,$556.65 ,90% of total billed charges for outpatient setting,$85.63 ,100% Medicaid OPPS fee schedule for outpatient setting,$538.10 ,87% of total billed charges for outpatient setting,$85.63 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$432.95 ,70% of total billed charges for outpatient setting,$85.63 ,$575.21 ,$494.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73560,Xray Knees Bilateral 1-2 views,302,$753.50 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$106.72 ,100% of BCBS Fee schedule for outpatient setting,$70.93 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$527.45 ,70% of total billed charges for outpatient setting,$678.15 ,90% of total billed charges for outpatient setting,$700.76 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$640.48 ,85% of total billed charges for outpatient setting,$678.15 ,90% of total billed charges for outpatient setting,$678.15 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$655.55 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$527.45 ,70% of total billed charges for outpatient setting,$21.07 ,$700.76 ,$602.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73562,Xray Knees Bilateral 3 views,302,$837.00 ,$23.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$148.12 ,100% of BCBS Fee schedule for outpatient setting,$84.90 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$585.90 ,70% of total billed charges for outpatient setting,$753.30 ,90% of total billed charges for outpatient setting,$778.41 ,93% of total billed charges for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$23.33 ,101% Medicaid OPPS fee schedule for outpatient setting,$711.45 ,85% of total billed charges for outpatient setting,$753.30 ,90% of total billed charges for outpatient setting,$753.30 ,90% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$728.19 ,87% of total billed charges for outpatient setting,$23.10 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$585.90 ,70% of total billed charges for outpatient setting,$23.10 ,$778.41 ,$669.60 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73564,Xray Knees Bilateral 4 or more views,302,$951.50 ,$25.01 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$214.36 ,100% of BCBS Fee schedule for outpatient setting,$96.25 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$666.05 ,70% of total billed charges for outpatient setting,$856.35 ,90% of total billed charges for outpatient setting,$884.90 ,93% of total billed charges for outpatient setting,$25.26 ,101% Medicaid OPPS fee schedule for outpatient setting,$25.26 ,101% Medicaid OPPS fee schedule for outpatient setting,$808.78 ,85% of total billed charges for outpatient setting,$856.35 ,90% of total billed charges for outpatient setting,$856.35 ,90% of total billed charges for outpatient setting,$25.01 ,100% Medicaid OPPS fee schedule for outpatient setting,$827.81 ,87% of total billed charges for outpatient setting,$25.01 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$666.05 ,70% of total billed charges for outpatient setting,$25.01 ,$884.90 ,$761.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73590,Xray Tibia/Fibula Lower Bilateral Leg,320,$868.50 ,$21.07 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$140.76 ,100% of BCBS Fee schedule for outpatient setting,$65.41 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$807.71 ,93% of total billed charges for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.28 ,101% Medicaid OPPS fee schedule for outpatient setting,$738.23 ,85% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$755.60 ,87% of total billed charges for outpatient setting,$21.07 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$21.07 ,$807.71 ,$694.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73610,Xray Ankles Bilateral,320,$868.50 ,$21.46 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$138.00 ,100% of BCBS Fee schedule for outpatient setting,$76.54 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$807.71 ,93% of total billed charges for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$738.23 ,85% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$781.65 ,90% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$755.60 ,87% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$607.95 ,70% of total billed charges for outpatient setting,$21.46 ,$807.71 ,$694.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73630,Xray Foot 3 or more views,320,$438.50 ,$21.46 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$133.40 ,100% of BCBS Fee schedule for outpatient setting,$71.70 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$306.95 ,70% of total billed charges for outpatient setting,$394.65 ,90% of total billed charges for outpatient setting,$407.81 ,93% of total billed charges for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$21.67 ,101% Medicaid OPPS fee schedule for outpatient setting,$372.73 ,85% of total billed charges for outpatient setting,$394.65 ,90% of total billed charges for outpatient setting,$394.65 ,90% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$381.50 ,87% of total billed charges for outpatient setting,$21.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$306.95 ,70% of total billed charges for outpatient setting,$21.46 ,$407.81 ,$350.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73700,CT Lower Extremity w/o Contrast,350,"$2,165.50 ",$198.41 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$282.15 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,515.85 ",70% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,"$2,013.92 ",93% of total billed charges for outpatient setting,$200.39 ,101% Medicaid OPPS fee schedule for outpatient setting,$200.39 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,840.68 ",85% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,"$1,948.95 ",90% of total billed charges for outpatient setting,$198.41 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,883.99 ",87% of total billed charges for outpatient setting,$198.41 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,515.85 ",70% of total billed charges for outpatient setting,$95.57 ,"$2,013.92 ","$1,732.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,73721,MRI Lower Extremity w/o Contrast,610,"$4,130.00 ",$474.59 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$521.00 ,100% of BCBS Fee schedule for outpatient setting,$443.61 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$2,891.00 ",70% of total billed charges for outpatient setting,"$3,717.00 ",90% of total billed charges for outpatient setting,"$3,840.90 ",93% of total billed charges for outpatient setting,$479.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$479.34 ,101% Medicaid OPPS fee schedule for outpatient setting,"$3,510.50 ",85% of total billed charges for outpatient setting,"$3,717.00 ",90% of total billed charges for outpatient setting,"$3,717.00 ",90% of total billed charges for outpatient setting,$474.59 ,100% Medicaid OPPS fee schedule for outpatient setting,"$3,593.10 ",87% of total billed charges for outpatient setting,$474.59 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,"$2,891.00 ",70% of total billed charges for outpatient setting,$208.81 ,"$3,840.90 ","$3,304.00 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74018,Xray Abdomen 1 view Decub Bilat,320,$896.00 ,$11.23 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$133.40 ,100% of BCBS Fee schedule for outpatient setting,$62.79 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$627.20 ,70% of total billed charges for outpatient setting,$806.40 ,90% of total billed charges for outpatient setting,$833.28 ,93% of total billed charges for outpatient setting,$11.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$11.34 ,101% Medicaid OPPS fee schedule for outpatient setting,$761.60 ,85% of total billed charges for outpatient setting,$806.40 ,90% of total billed charges for outpatient setting,$806.40 ,90% of total billed charges for outpatient setting,$11.23 ,100% Medicaid OPPS fee schedule for outpatient setting,$779.52 ,87% of total billed charges for outpatient setting,$11.23 ,100% Medicaid OPPS fee schedule for outpatient setting,$77.68 ,pay at 100% of APC for outpatient setting,$627.20 ,70% of total billed charges for outpatient setting,$11.23 ,$833.28 ,$716.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74019,Xray Abdomen 2 views,320,$610.50 ,$13.46 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$99.36 ,100% of BCBS Fee schedule for outpatient setting,$76.96 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$427.35 ,70% of total billed charges for outpatient setting,$549.45 ,90% of total billed charges for outpatient setting,$567.77 ,93% of total billed charges for outpatient setting,$13.59 ,101% Medicaid OPPS fee schedule for outpatient setting,$13.59 ,101% Medicaid OPPS fee schedule for outpatient setting,$518.93 ,85% of total billed charges for outpatient setting,$549.45 ,90% of total billed charges for outpatient setting,$549.45 ,90% of total billed charges for outpatient setting,$13.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$531.14 ,87% of total billed charges for outpatient setting,$13.46 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$427.35 ,70% of total billed charges for outpatient setting,$13.46 ,$567.77 ,$488.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74022,Xray Abdomen Series with Chest 1 view,320,$923.00 ,$29.74 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$261.28 ,100% of BCBS Fee schedule for outpatient setting,$104.54 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$646.10 ,70% of total billed charges for outpatient setting,$830.70 ,90% of total billed charges for outpatient setting,$858.39 ,93% of total billed charges for outpatient setting,$30.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$30.04 ,101% Medicaid OPPS fee schedule for outpatient setting,$784.55 ,85% of total billed charges for outpatient setting,$830.70 ,90% of total billed charges for outpatient setting,$830.70 ,90% of total billed charges for outpatient setting,$29.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$803.01 ,87% of total billed charges for outpatient setting,$29.74 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$646.10 ,70% of total billed charges for outpatient setting,$29.74 ,$858.39 ,$738.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74176,CT Abdomen/Pelvis w/o Contrast,350,"$5,035.50 ",$79.44 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$400.03 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$3,524.85 ",70% of total billed charges for outpatient setting,"$4,531.95 ",90% of total billed charges for outpatient setting,"$4,683.02 ",93% of total billed charges for outpatient setting,$80.23 ,101% Medicaid OPPS fee schedule for outpatient setting,$80.23 ,101% Medicaid OPPS fee schedule for outpatient setting,"$4,280.18 ",85% of total billed charges for outpatient setting,"$4,531.95 ",90% of total billed charges for outpatient setting,"$4,531.95 ",90% of total billed charges for outpatient setting,$79.44 ,100% Medicaid OPPS fee schedule for outpatient setting,"$4,380.89 ",87% of total billed charges for outpatient setting,$79.44 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,"$3,524.85 ",70% of total billed charges for outpatient setting,$79.44 ,"$4,683.02 ","$4,028.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74177,CT Abdomen/Pelvis with Contrast,350,"$5,777.00 ",$151.39 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$674.67 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$4,043.90 ",70% of total billed charges for outpatient setting,"$5,199.30 ",90% of total billed charges for outpatient setting,"$5,372.61 ",93% of total billed charges for outpatient setting,$152.90 ,101% Medicaid OPPS fee schedule for outpatient setting,$152.90 ,101% Medicaid OPPS fee schedule for outpatient setting,"$4,910.45 ",85% of total billed charges for outpatient setting,"$5,199.30 ",90% of total billed charges for outpatient setting,"$5,199.30 ",90% of total billed charges for outpatient setting,$151.39 ,100% Medicaid OPPS fee schedule for outpatient setting,"$5,025.99 ",87% of total billed charges for outpatient setting,$151.39 ,100% Medicaid OPPS fee schedule for outpatient setting,$329.45 ,pay at 100% of APC for outpatient setting,"$4,043.90 ",70% of total billed charges for outpatient setting,$151.39 ,"$5,372.61 ","$4,621.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74178,CT Abodmen/Pelvis with & w/o Contrast,350,"$6,489.00 ",$200.25 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$453.00 ,100% of BCBS Fee schedule for outpatient setting,$755.52 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$4,542.30 ",70% of total billed charges for outpatient setting,"$5,840.10 ",90% of total billed charges for outpatient setting,"$6,034.77 ",93% of total billed charges for outpatient setting,$202.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$202.25 ,101% Medicaid OPPS fee schedule for outpatient setting,"$5,515.65 ",85% of total billed charges for outpatient setting,"$5,840.10 ",90% of total billed charges for outpatient setting,"$5,840.10 ",90% of total billed charges for outpatient setting,$200.25 ,100% Medicaid OPPS fee schedule for outpatient setting,"$5,645.43 ",87% of total billed charges for outpatient setting,$200.25 ,100% Medicaid OPPS fee schedule for outpatient setting,$329.45 ,pay at 100% of APC for outpatient setting,"$4,542.30 ",70% of total billed charges for outpatient setting,$200.25 ,"$6,034.77 ","$5,191.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,74420,Xray Urninary Tract,320,"$1,396.00 ",$44.48 ,100% KS Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$160.91 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$977.20 ,70% of total billed charges for outpatient setting,"$1,256.40 ",90% of total billed charges for outpatient setting,"$1,298.28 ",93% of total billed charges for outpatient setting,$44.92 ,101% Medicaid OPPS fee schedule for outpatient setting,$44.92 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,186.60 ",85% of total billed charges for outpatient setting,"$1,256.40 ",90% of total billed charges for outpatient setting,"$1,256.40 ",90% of total billed charges for outpatient setting,$44.48 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,214.52 ",87% of total billed charges for outpatient setting,$44.48 ,100% Medicaid OPPS fee schedule for outpatient setting,$329.45 ,pay at 100% of APC for outpatient setting,$977.20 ,70% of total billed charges for outpatient setting,$44.48 ,"$1,298.28 ","$1,116.80 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76000,Fluoroscopy image guidance,320,$910.00 ,$37.22 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$231.84 ,100% of BCBS Fee schedule for outpatient setting,$88.86 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$637.00 ,70% of total billed charges for outpatient setting,$819.00 ,90% of total billed charges for outpatient setting,$846.30 ,93% of total billed charges for outpatient setting,$37.59 ,101% Medicaid OPPS fee schedule for outpatient setting,$37.59 ,101% Medicaid OPPS fee schedule for outpatient setting,$773.50 ,85% of total billed charges for outpatient setting,$819.00 ,90% of total billed charges for outpatient setting,$819.00 ,90% of total billed charges for outpatient setting,$37.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$791.70 ,87% of total billed charges for outpatient setting,$37.22 ,100% Medicaid OPPS fee schedule for outpatient setting,$208.81 ,pay at 100% of APC for outpatient setting,$637.00 ,70% of total billed charges for outpatient setting,$37.22 ,$846.30 ,$728.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76376,MRI 3D,610,"$1,198.50 ",$126.39 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$315.56 ,100% of BCBS Fee schedule for outpatient setting,$47.72 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$838.95 ,70% of total billed charges for outpatient setting,"$1,078.65 ",90% of total billed charges for outpatient setting,"$1,114.61 ",93% of total billed charges for outpatient setting,$127.65 ,101% Medicaid OPPS fee schedule for outpatient setting,$127.65 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,018.73 ",85% of total billed charges for outpatient setting,"$1,078.65 ",90% of total billed charges for outpatient setting,"$1,078.65 ",90% of total billed charges for outpatient setting,$126.39 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,042.70 ",87% of total billed charges for outpatient setting,$126.39 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$838.95 ,70% of total billed charges for outpatient setting,$47.72 ,"$1,114.61 ",$958.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76536,Ultrasound Thyroid/Soft Tissue Head/Neck,402,$901.50 ,$25.90 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$476.00 ,100% of BCBS Fee schedule for outpatient setting,$235.16 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$631.05 ,70% of total billed charges for outpatient setting,$811.35 ,90% of total billed charges for outpatient setting,$838.40 ,93% of total billed charges for outpatient setting,$26.16 ,101% Medicaid OPPS fee schedule for outpatient setting,$26.16 ,101% Medicaid OPPS fee schedule for outpatient setting,$766.28 ,85% of total billed charges for outpatient setting,$811.35 ,90% of total billed charges for outpatient setting,$811.35 ,90% of total billed charges for outpatient setting,$25.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$784.31 ,87% of total billed charges for outpatient setting,$25.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$631.05 ,70% of total billed charges for outpatient setting,$25.90 ,$838.40 ,$721.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76641,Ultrasound Breast Bilateral,402,"$1,241.50 ",$53.43 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$94.00 ,100% of BCBS Fee schedule for outpatient setting,$217.69 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$869.05 ,70% of total billed charges for outpatient setting,"$1,117.35 ",90% of total billed charges for outpatient setting,"$1,154.60 ",93% of total billed charges for outpatient setting,$53.96 ,101% Medicaid OPPS fee schedule for outpatient setting,$53.96 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,055.28 ",85% of total billed charges for outpatient setting,"$1,117.35 ",90% of total billed charges for outpatient setting,"$1,117.35 ",90% of total billed charges for outpatient setting,$53.43 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,080.11 ",87% of total billed charges for outpatient setting,$53.43 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$869.05 ,70% of total billed charges for outpatient setting,$53.43 ,"$1,154.60 ",$993.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound Abdomen,402,"$1,229.00 ",$78.90 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$150.00 ,100% of BCBS Fee schedule for outpatient setting,$247.98 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$860.30 ,70% of total billed charges for outpatient setting,"$1,106.10 ",90% of total billed charges for outpatient setting,"$1,142.97 ",93% of total billed charges for outpatient setting,$79.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$79.69 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,044.65 ",85% of total billed charges for outpatient setting,"$1,106.10 ",90% of total billed charges for outpatient setting,"$1,106.10 ",90% of total billed charges for outpatient setting,$78.90 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,069.23 ",87% of total billed charges for outpatient setting,$78.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$860.30 ,70% of total billed charges for outpatient setting,$78.90 ,"$1,142.97 ",$983.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76705,Ultrasound Spleen/Liver/Gallbladder/Pancreas,402,"$1,179.00 ",$48.81 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$116.00 ,100% of BCBS Fee schedule for outpatient setting,$184.91 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$825.30 ,70% of total billed charges for outpatient setting,"$1,061.10 ",90% of total billed charges for outpatient setting,"$1,096.47 ",93% of total billed charges for outpatient setting,$49.30 ,101% Medicaid OPPS fee schedule for outpatient setting,$49.30 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,002.15 ",85% of total billed charges for outpatient setting,"$1,061.10 ",90% of total billed charges for outpatient setting,"$1,061.10 ",90% of total billed charges for outpatient setting,$48.81 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,025.73 ",87% of total billed charges for outpatient setting,$48.81 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$825.30 ,70% of total billed charges for outpatient setting,$48.81 ,"$1,096.47 ",$943.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76770,Ultrasound Kidney/Bladder/Aorta,402,"$1,192.50 ",$78.90 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$150.00 ,100% of BCBS Fee schedule for outpatient setting,$229.50 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$834.75 ,70% of total billed charges for outpatient setting,"$1,073.25 ",90% of total billed charges for outpatient setting,"$1,109.03 ",93% of total billed charges for outpatient setting,$79.69 ,101% Medicaid OPPS fee schedule for outpatient setting,$79.69 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,013.63 ",85% of total billed charges for outpatient setting,"$1,073.25 ",90% of total billed charges for outpatient setting,"$1,073.25 ",90% of total billed charges for outpatient setting,$78.90 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,037.48 ",87% of total billed charges for outpatient setting,$78.90 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$834.75 ,70% of total billed charges for outpatient setting,$78.90 ,"$1,109.03 ",$954.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76801,Ultrasound OB Fetus < 14 weeks gestation,402,"$1,782.00 ",$76.00 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$69.00 ,100% of BCBS Fee schedule for outpatient setting,$248.56 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,247.40 ",70% of total billed charges for outpatient setting,"$1,603.80 ",90% of total billed charges for outpatient setting,"$1,657.26 ",93% of total billed charges for outpatient setting,$76.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$76.76 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,514.70 ",85% of total billed charges for outpatient setting,"$1,603.80 ",90% of total billed charges for outpatient setting,"$1,603.80 ",90% of total billed charges for outpatient setting,$76.00 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,550.34 ",87% of total billed charges for outpatient setting,$76.00 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,"$1,247.40 ",70% of total billed charges for outpatient setting,$69.00 ,"$1,657.26 ","$1,425.60 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76805,Ultrasound OB Fetus > 14 weeks gestation,402,"$1,101.00 ",$76.00 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$131.00 ,100% of BCBS Fee schedule for outpatient setting,$285.19 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$770.70 ,70% of total billed charges for outpatient setting,$990.90 ,90% of total billed charges for outpatient setting,"$1,023.93 ",93% of total billed charges for outpatient setting,$76.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$76.76 ,101% Medicaid OPPS fee schedule for outpatient setting,$935.85 ,85% of total billed charges for outpatient setting,$990.90 ,90% of total billed charges for outpatient setting,$990.90 ,90% of total billed charges for outpatient setting,$76.00 ,100% Medicaid OPPS fee schedule for outpatient setting,$957.87 ,87% of total billed charges for outpatient setting,$76.00 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$770.70 ,70% of total billed charges for outpatient setting,$76.00 ,"$1,023.93 ",$880.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound Transvaginal Non-OB,402,"$1,137.50 ",$64.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$252.67 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$796.25 ,70% of total billed charges for outpatient setting,"$1,023.75 ",90% of total billed charges for outpatient setting,"$1,057.88 ",93% of total billed charges for outpatient setting,$65.36 ,101% Medicaid OPPS fee schedule for outpatient setting,$65.36 ,101% Medicaid OPPS fee schedule for outpatient setting,$966.88 ,85% of total billed charges for outpatient setting,"$1,023.75 ",90% of total billed charges for outpatient setting,"$1,023.75 ",90% of total billed charges for outpatient setting,$64.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$989.63 ,87% of total billed charges for outpatient setting,$64.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$796.25 ,70% of total billed charges for outpatient setting,$64.71 ,"$1,057.88 ",$910.00 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76856,Ultrasound Pelvis,402,"$1,256.50 ",$64.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$223.63 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$879.55 ,70% of total billed charges for outpatient setting,"$1,130.85 ",90% of total billed charges for outpatient setting,"$1,168.55 ",93% of total billed charges for outpatient setting,$65.36 ,101% Medicaid OPPS fee schedule for outpatient setting,$65.36 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,068.03 ",85% of total billed charges for outpatient setting,"$1,130.85 ",90% of total billed charges for outpatient setting,"$1,130.85 ",90% of total billed charges for outpatient setting,$64.71 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,093.16 ",87% of total billed charges for outpatient setting,$64.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$879.55 ,70% of total billed charges for outpatient setting,$64.71 ,"$1,168.55 ","$1,005.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,76870,Ultrasound Testicular/Scrotum,402,"$1,096.50 ",$46.12 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$212.92 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$767.55 ,70% of total billed charges for outpatient setting,$986.85 ,90% of total billed charges for outpatient setting,"$1,019.75 ",93% of total billed charges for outpatient setting,$46.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$46.58 ,101% Medicaid OPPS fee schedule for outpatient setting,$932.03 ,85% of total billed charges for outpatient setting,$986.85 ,90% of total billed charges for outpatient setting,$986.85 ,90% of total billed charges for outpatient setting,$46.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$953.96 ,87% of total billed charges for outpatient setting,$46.12 ,100% Medicaid OPPS fee schedule for outpatient setting,$95.57 ,pay at 100% of APC for outpatient setting,$767.55 ,70% of total billed charges for outpatient setting,$46.12 ,"$1,019.75 ",$877.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,77062,Mammography Tomography Diagnostic Digital,401,$100.50 ,$19.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$26.40 ,100% of BCBS Fee schedule for outpatient setting,N/A,Not separately reimbursable,$70.35 ,70% of total billed charges for outpatient setting,$90.45 ,90% of total billed charges for outpatient setting,$93.47 ,93% of total billed charges for outpatient setting,$19.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$85.43 ,85% of total billed charges for outpatient setting,$90.45 ,90% of total billed charges for outpatient setting,$90.45 ,90% of total billed charges for outpatient setting,$19.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$87.44 ,87% of total billed charges for outpatient setting,$19.71 ,100% Medicaid OPPS fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$70.35 ,70% of total billed charges for outpatient setting,$19.71 ,$93.47 ,$80.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,77063,Mammography Tomography Screening Digital,403,$201.50 ,$19.71 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$77.00 ,100% of BCBS Fee schedule for outpatient setting,$110.66 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$141.05 ,70% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$187.40 ,93% of total billed charges for outpatient setting,$19.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$19.91 ,101% Medicaid OPPS fee schedule for outpatient setting,$171.28 ,85% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$181.35 ,90% of total billed charges for outpatient setting,$19.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$175.31 ,87% of total billed charges for outpatient setting,$19.71 ,100% Medicaid OPPS fee schedule for outpatient setting,$22.12 ,100% CMS Medicare physician fee schedule for outpatient setting,$141.05 ,70% of total billed charges for outpatient setting,$19.71 ,$187.40 ,$161.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,77065,Mammography Unilateral Diagnostic,401,$489.00 ,$60.64 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$263.87 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$342.30 ,70% of total billed charges for outpatient setting,$440.10 ,90% of total billed charges for outpatient setting,$454.77 ,93% of total billed charges for outpatient setting,$61.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$61.25 ,101% Medicaid OPPS fee schedule for outpatient setting,$415.65 ,85% of total billed charges for outpatient setting,$440.10 ,90% of total billed charges for outpatient setting,$440.10 ,90% of total billed charges for outpatient setting,$60.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$425.43 ,87% of total billed charges for outpatient setting,$60.64 ,100% Medicaid OPPS fee schedule for outpatient setting,$80.38 ,100% CMS Medicare physician fee schedule for outpatient setting,$342.30 ,70% of total billed charges for outpatient setting,$60.64 ,$454.77 ,$391.20 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,77066,Mammography Bilateral Diagnostic,401,$853.50 ,$75.33 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$333.30 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$597.45 ,70% of total billed charges for outpatient setting,$768.15 ,90% of total billed charges for outpatient setting,$793.76 ,93% of total billed charges for outpatient setting,$76.08 ,101% Medicaid OPPS fee schedule for outpatient setting,$76.08 ,101% Medicaid OPPS fee schedule for outpatient setting,$725.48 ,85% of total billed charges for outpatient setting,$768.15 ,90% of total billed charges for outpatient setting,$768.15 ,90% of total billed charges for outpatient setting,$75.33 ,100% Medicaid OPPS fee schedule for outpatient setting,$742.55 ,87% of total billed charges for outpatient setting,$75.33 ,100% Medicaid OPPS fee schedule for outpatient setting,$102.51 ,100% CMS Medicare physician fee schedule for outpatient setting,$597.45 ,70% of total billed charges for outpatient setting,$75.33 ,$793.76 ,$682.80 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,77067,Mammography Screening,403,$375.50 ,$73.06 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$122.00 ,100% of BCBS Fee schedule for outpatient setting,$268.36 ,220% CMS Medicare Physician fee  schedule for outpatient setting,$262.85 ,70% of total billed charges for outpatient setting,$337.95 ,90% of total billed charges for outpatient setting,$349.22 ,93% of total billed charges for outpatient setting,$73.79 ,101% Medicaid OPPS fee schedule for outpatient setting,$73.79 ,101% Medicaid OPPS fee schedule for outpatient setting,$319.18 ,85% of total billed charges for outpatient setting,$337.95 ,90% of total billed charges for outpatient setting,$337.95 ,90% of total billed charges for outpatient setting,$73.06 ,100% Medicaid OPPS fee schedule for outpatient setting,$326.69 ,87% of total billed charges for outpatient setting,$73.06 ,100% Medicaid OPPS fee schedule for outpatient setting,$84.99 ,100% CMS Medicare physician fee schedule for outpatient setting,$262.85 ,70% of total billed charges for outpatient setting,$73.06 ,$349.22 ,$300.40 ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,78227,Nuclear Medicine Hepato-Biliary Scan,340,"$2,225.50 ",$249.47 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$524.40 ,100% of BCBS Fee schedule for outpatient setting,$859.03 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$1,557.85 ",70% of total billed charges for outpatient setting,"$2,002.95 ",90% of total billed charges for outpatient setting,"$2,069.72 ",93% of total billed charges for outpatient setting,$251.96 ,101% Medicaid OPPS fee schedule for outpatient setting,$251.96 ,101% Medicaid OPPS fee schedule for outpatient setting,"$1,891.68 ",85% of total billed charges for outpatient setting,"$2,002.95 ",90% of total billed charges for outpatient setting,"$2,002.95 ",90% of total billed charges for outpatient setting,$249.47 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,936.19 ",87% of total billed charges for outpatient setting,$249.47 ,100% Medicaid OPPS fee schedule for outpatient setting,$451.13 ,pay at 100% of APC for outpatient setting,"$1,557.85 ",70% of total billed charges for outpatient setting,$249.47 ,"$2,069.72 ","$1,780.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,78452,Nuclear Medicine Cardiac Treadmill,340,"$4,363.00 ",$201.10 ,100% KS Medicaid OPPS fee schedule for outpatient setting,$835.00 ,100% of BCBS Fee schedule for outpatient setting,$933.92 ,220% CMS Medicare Physician fee  schedule for outpatient setting,"$3,054.10 ",70% of total billed charges for outpatient setting,"$3,926.70 ",90% of total billed charges for outpatient setting,"$4,057.59 ",93% of total billed charges for outpatient setting,$203.11 ,101% Medicaid OPPS fee schedule for outpatient setting,$203.11 ,101% Medicaid OPPS fee schedule for outpatient setting,"$3,708.55 ",85% of total billed charges for outpatient setting,"$3,926.70 ",90% of total billed charges for outpatient setting,"$3,926.70 ",90% of total billed charges for outpatient setting,$201.10 ,100% Medicaid OPPS fee schedule for outpatient setting,"$3,795.81 ",87% of total billed charges for outpatient setting,$201.10 ,100% Medicaid OPPS fee schedule for outpatient setting,"$1,186.86 ",pay at 100% of APC for outpatient setting,"$3,054.10 ",70% of total billed charges for outpatient setting,$201.10 ,"$4,057.59 ","$3,490.40 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,189,Pulmonary Edema and Respiratory Failure,100,"$34,926.14 ","$6,279.29 ",Pays at 100% of Medicaid DRG rate ,"$12,299.00 ",100% of BCBS DRG rate ,"$27,940.91 ",80% of billed charges for inpatient setting,"$13,064.57 ",100% of Healthchoice DRG rate,"$31,433.53 ",90% of billed charges for inpatient setting,"$32,481.31 ",93% of billed charges for inpatient setting ,"$6,404.88 ",102% of Medicaid DRG rate,"$6,342.08 ",101% of Medicaid DRG rate,"$29,687.22 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$31,433.53 ",90%of billed charges for inpatient setting,"$6,279.29 ",100% of Medicaid DRG rate,"$30,385.74 ",87% of billed charges for inpatient setting,"$6,279.29 ",100% of Medicaid DRG rate,"$12,100.15 ",Pays at 100% of Medicaid IPPS rate,"$24,448.30 ",70% of billed charges for inpatient setting,"$2,263.16 ","$32,481.31 ","$27,940.91 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,193,Simple Pneumonia and Pleurisy w/MCC,100,"$38,496.41 ","$5,737.69 ",Pays at 100% of Medicaid DRG rate ,"$11,035.58 ",100% of BCBS DRG rate ,"$30,797.13 ",80% of billed charges for inpatient setting,"$14,057.13 ",100% of Healthchoice DRG rate,"$34,646.77 ",90% of billed charges for inpatient setting,"$35,801.66 ",93% of billed charges for inpatient setting ,"$5,852.44 ",102% of Medicaid DRG rate,"$5,795.07 ",101% of Medicaid DRG rate,"$32,721.95 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$34,646.77 ",90%of billed charges for inpatient setting,"$5,737.69 ",100% of Medicaid DRG rate,"$33,491.88 ",87% of billed charges for inpatient setting,"$5,737.69 ",100% of Medicaid DRG rate,"$13,029.28 ",Pays at 100% of Medicaid IPPS rate,"$26,947.49 ",70% of billed charges for inpatient setting,"$2,263.16 ","$35,801.66 ","$30,797.13 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,203,Bronchitis and Asthma w/o CC/MCC,100,"$26,388.40 ","$2,983.47 ",Pays at 100% of Medicaid DRG rate ,"$6,036.89 ",100% of BCBS DRG rate ,"$21,110.72 ",80% of billed charges for inpatient setting,"$7,220.69 ",100% of Healthchoice DRG rate,"$23,749.56 ",90% of billed charges for inpatient setting,"$24,541.21 ",93% of billed charges for inpatient setting ,"$3,043.14 ",102% of Medicaid DRG rate,"$3,013.30 ",101% of Medicaid DRG rate,"$22,430.14 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$23,749.56 ",90%of billed charges for inpatient setting,"$2,983.47 ",100% of Medicaid DRG rate,"$22,957.91 ",87% of billed charges for inpatient setting,"$2,983.47 ",100% of Medicaid DRG rate,"$6,825.00 ",Pays at 100% of Medicaid IPPS rate,"$18,471.88 ",70% of billed charges for inpatient setting,"$2,263.16 ","$24,541.21 ","$21,110.72 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,291,Heart Failure and Shock w/MCC,100,"$50,168.81 ","$8,053.38 ",Pays at 100% of Medicaid DRG rate ,"$12,804.03 ",100% of BCBS DRG rate ,"$40,135.05 ",80% of billed charges for inpatient setting,"$13,852.56 ",100% of Healthchoice DRG rate,"$45,151.93 ",90% of billed charges for inpatient setting,"$46,656.99 ",93% of billed charges for inpatient setting ,"$8,214.45 ",102% of Medicaid DRG rate,"$8,133.91 ",101% of Medicaid DRG rate,"$42,643.49 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$45,151.93 ",90%of billed charges for inpatient setting,"$8,053.38 ",100% of Medicaid DRG rate,"$43,646.86 ",87% of billed charges for inpatient setting,"$8,053.38 ",100% of Medicaid DRG rate,"$12,609.91 ",Pays at 100% of Medicaid IPPS rate,"$35,118.17 ",70% of billed charges for inpatient setting,"$2,263.16 ","$46,656.99 ","$40,135.05 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,305,Hypertension w/o MCC,100,"$33,112.21 ","$3,686.36 ",Pays at 100% of Medicaid DRG rate ,"$6,038.04 ",100% of BCBS DRG rate ,"$26,489.77 ",80% of billed charges for inpatient setting,"$8,070.37 ",100% of Healthchoice DRG rate,"$29,800.99 ",90% of billed charges for inpatient setting,"$30,794.36 ",93% of billed charges for inpatient setting ,"$3,760.09 ",102% of Medicaid DRG rate,"$3,723.22 ",101% of Medicaid DRG rate,"$28,145.38 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$29,800.99 ",90%of billed charges for inpatient setting,"$3,686.36 ",100% of Medicaid DRG rate,"$28,807.62 ",87% of billed charges for inpatient setting,"$3,686.36 ",100% of Medicaid DRG rate,"$7,400.55 ",Pays at 100% of Medicaid IPPS rate,"$23,178.55 ",70% of billed charges for inpatient setting,"$2,263.16 ","$30,794.36 ","$26,489.77 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,309,Cardiac Arrhythmia and Conduction Disorders w/CC,100,"$31,001.05 ","$5,480.88 ",Pays at 100% of Medicaid DRG rate ,"$6,697.35 ",100% of BCBS DRG rate ,"$24,800.84 ",80% of billed charges for inpatient setting,"$7,983.78 ",100% of Healthchoice DRG rate,"$27,900.95 ",90% of billed charges for inpatient setting,"$28,830.98 ",93% of billed charges for inpatient setting ,"$5,590.50 ",102% of Medicaid DRG rate,"$5,535.69 ",101% of Medicaid DRG rate,"$26,350.89 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$27,900.95 ",90%of billed charges for inpatient setting,"$5,480.88 ",100% of Medicaid DRG rate,"$26,970.91 ",87% of billed charges for inpatient setting,"$5,480.88 ",100% of Medicaid DRG rate,"$7,314.12 ",Pays at 100% of Medicaid IPPS rate,"$21,700.74 ",70% of billed charges for inpatient setting,"$2,263.16 ","$28,830.98 ","$24,800.84 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,392,Esophagitis Gastroenteritis and Misc Digestive Disorders,100,"$22,320.70 ","$3,613.94 ",Pays at 100% of Medicaid DRG rate ,"$6,627.09 ",100% of BCBS DRG rate ,"$17,856.56 ",80% of billed charges for inpatient setting,"$8,524.98 ",100% of Healthchoice DRG rate,"$20,088.63 ",90% of billed charges for inpatient setting,"$20,758.25 ",93% of billed charges for inpatient setting ,"$3,686.22 ",102% of Medicaid DRG rate,"$3,650.08 ",101% of Medicaid DRG rate,"$18,972.60 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$20,088.63 ",90%of billed charges for inpatient setting,"$3,613.94 ",100% of Medicaid DRG rate,"$19,419.01 ",87% of billed charges for inpatient setting,"$3,613.94 ",100% of Medicaid DRG rate,"$7,715.82 ",Pays at 100% of Medicaid IPPS rate,"$15,624.49 ",70% of billed charges for inpatient setting,"$2,263.16 ","$20,758.25 ","$17,856.56 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,470,Major Hip and Knee Joint Replacement or Reattach Lower Extremity,100,"$76,952.10 ","$8,979.75 ",Pays at 100% of Medicaid DRG rate ,"$21,717.69 ",100% of BCBS DRG rate ,"$61,561.68 ",80% of billed charges for inpatient setting,"$20,694.41 ",100% of Healthchoice DRG rate,"$69,256.89 ",90% of billed charges for inpatient setting,"$71,565.45 ",93% of billed charges for inpatient setting ,"$9,159.35 ",102% of Medicaid DRG rate,"$9,069.55 ",101% of Medicaid DRG rate,"$65,409.29 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$69,256.89 ",90%of billed charges for inpatient setting,"$8,979.75 ",100% of Medicaid DRG rate,"$66,948.33 ",87% of billed charges for inpatient setting,"$8,979.75 ",100% of Medicaid DRG rate,"$18,481.23 ",Pays at 100% of Medicaid IPPS rate,"$53,866.47 ",70% of billed charges for inpatient setting,"$3,487.92 ","$71,565.45 ","$61,561.68 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,481,Hip and Femur Procedures Except Major Joint w/CC,100,"$74,338.06 ","$11,507.37 ",Pays at 100% of Medicaid DRG rate ,"$19,475.00 ",100% of BCBS DRG rate ,"$59,470.45 ",80% of billed charges for inpatient setting,"$22,864.62 ",100% of Healthchoice DRG rate,"$66,904.25 ",90% of billed charges for inpatient setting,"$69,134.40 ",93% of billed charges for inpatient setting ,"$11,737.52 ",102% of Medicaid DRG rate,"$11,622.44 ",101% of Medicaid DRG rate,"$63,187.35 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$66,904.25 ",90%of billed charges for inpatient setting,"$11,507.37 ",100% of Medicaid DRG rate,"$64,674.11 ",87% of billed charges for inpatient setting,"$11,507.37 ",100% of Medicaid DRG rate,"$20,378.76 ",Pays at 100% of Medicaid IPPS rate,"$52,036.64 ",70% of billed charges for inpatient setting,"$3,487.92 ","$69,134.40 ","$59,470.45 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,483,Major Joint or Limb Reattachment Procedures of Upper Extremities,100,"$63,217.66 ","$10,094.05 ",Pays at 100% of Medicaid DRG rate ,"$17,794.66 ",100% of BCBS DRG rate ,"$50,574.13 ",80% of billed charges for inpatient setting,"$25,518.66 ",100% of Healthchoice DRG rate,"$56,895.89 ",90% of billed charges for inpatient setting,"$58,792.42 ",93% of billed charges for inpatient setting ,"$10,295.93 ",102% of Medicaid DRG rate,"$10,194.99 ",101% of Medicaid DRG rate,"$53,735.01 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$56,895.89 ",90%of billed charges for inpatient setting,"$10,094.05 ",100% of Medicaid DRG rate,"$54,999.36 ",87% of billed charges for inpatient setting,"$10,094.05 ",100% of Medicaid DRG rate,"$24,398.72 ",Pays at 100% of Medicaid IPPS rate,"$44,252.36 ",70% of billed charges for inpatient setting,"$3,487.92 ","$58,792.42 ","$50,574.13 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,494,Lower Extermity and Humerus Procedures Except Hip Foot and Femur w/CC/MCC,100,"$65,807.33 ","$5,588.41 ",Pays at 100% of Medicaid DRG rate ,"$9,880.42 ",100% of BCBS DRG rate ,"$52,645.86 ",80% of billed charges for inpatient setting,"$20,444.37 ",100% of Healthchoice DRG rate,"$59,226.60 ",90% of billed charges for inpatient setting,"$61,200.82 ",93% of billed charges for inpatient setting ,"$5,700.18 ",102% of Medicaid DRG rate,"$5,644.29 ",101% of Medicaid DRG rate,"$55,936.23 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$59,226.60 ",90%of billed charges for inpatient setting,"$5,588.41 ",100% of Medicaid DRG rate,"$57,252.38 ",87% of billed charges for inpatient setting,"$5,588.41 ",100% of Medicaid DRG rate,"$18,358.46 ",Pays at 100% of Medicaid IPPS rate,"$46,065.13 ",70% of billed charges for inpatient setting,"$3,487.92 ","$61,200.82 ","$52,645.86 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,522,Hip Replacement w/Principle Diagnosis of Hip Fracture w/o MCC,100,"$87,566.24 ","$12,191.15 ",Pays at 100% of Medicaid DRG rate ,N/A,Not separately reimbursable per CMS guidelines,"$70,052.99 ",80% of billed charges for inpatient setting,"$23,519.47 ",100% of Healthchoice DRG rate,"$78,809.62 ",90% of billed charges for inpatient setting,"$81,436.60 ",93% of billed charges for inpatient setting ,"$12,434.97 ",102% of Medicaid DRG rate,"$12,313.06 ",101% of Medicaid DRG rate,"$74,431.30 ",85%of billed charges for inpatient setting,N/A,Not separately reimbursable,"$78,809.62 ",90%of billed charges for inpatient setting,"$12,191.15 ",100% of Medicaid DRG rate,"$76,182.63 ",87% of billed charges for inpatient setting,"$12,191.15 ",100% of Medicaid DRG rate,"$20,745.10 ",Pays at 100% of Medicaid IPPS rate,"$61,296.37 ",70% of billed charges for inpatient setting,"$12,191.15 ","$81,436.60 ","$70,052.99 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,603,Cellulitis w/o MCC,100,"$20,681.41 ","$3,854.75 ",Pays at 100% of Medicaid DRG rate ,"$7,409.14 ",100% of BCBS DRG rate ,"$16,545.13 ",80% of billed charges for inpatient setting,"$9,544.60 ",100% of Healthchoice DRG rate,"$18,613.27 ",90% of billed charges for inpatient setting,"$19,233.71 ",93% of billed charges for inpatient setting ,"$3,931.85 ",102% of Medicaid DRG rate,"$3,893.30 ",101% of Medicaid DRG rate,"$17,579.20 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$18,613.27 ",90%of billed charges for inpatient setting,"$3,854.75 ",100% of Medicaid DRG rate,"$17,992.83 ",87% of billed charges for inpatient setting,"$3,854.75 ",100% of Medicaid DRG rate,"$8,689.12 ",Pays at 100% of Medicaid IPPS rate,"$14,476.99 ",70% of billed charges for inpatient setting,"$2,263.16 ","$19,233.71 ","$16,545.13 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,617,"Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disease",100,"$42,918.04 ","$9,574.22 ",Pays at 100% of Medicaid DRG rate ,"$14,877.11 ",100% of BCBS DRG rate ,"$34,334.43 ",80% of billed charges for inpatient setting,"$21,041.86 ",100% of Healthchoice DRG rate,"$38,626.24 ",90% of billed charges for inpatient setting,"$39,913.78 ",93% of billed charges for inpatient setting ,"$9,765.70 ",102% of Medicaid DRG rate,"$9,669.96 ",101% of Medicaid DRG rate,"$36,480.33 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$38,626.24 ",90%of billed charges for inpatient setting,"$9,574.22 ",100% of Medicaid DRG rate,"$37,338.69 ",87% of billed charges for inpatient setting,"$9,574.22 ",100% of Medicaid DRG rate,"$19,490.89 ",Pays at 100% of Medicaid IPPS rate,"$30,042.63 ",70% of billed charges for inpatient setting,"$3,487.92 ","$39,913.78 ","$34,334.43 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,638,Diabetes w/CC,100,"$31,609.64 ","$4,677.59 ",Pays at 100% of Medicaid DRG rate ,"$7,355.26 ",100% of BCBS DRG rate ,"$25,287.71 ",80% of billed charges for inpatient setting,"$9,481.82 ",100% of Healthchoice DRG rate,"$28,448.68 ",90% of billed charges for inpatient setting,"$29,396.97 ",93% of billed charges for inpatient setting ,"$4,771.14 ",102% of Medicaid DRG rate,"$4,724.37 ",101% of Medicaid DRG rate,"$26,868.19 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$28,448.68 ",90%of billed charges for inpatient setting,"$4,677.59 ",100% of Medicaid DRG rate,"$27,500.39 ",87% of billed charges for inpatient setting,"$4,677.59 ",100% of Medicaid DRG rate,"$8,833.51 ",Pays at 100% of Medicaid IPPS rate,"$22,126.75 ",70% of billed charges for inpatient setting,"$2,263.16 ","$29,396.97 ","$25,287.71 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,641,Misc disorders of Nutrition Metabolism Fluids and Electrolytes,100,"$23,856.64 ","$4,250.62 ",Pays at 100% of Medicaid DRG rate ,"$6,524.34 ",100% of BCBS DRG rate ,"$19,085.31 ",80% of billed charges for inpatient setting,"$8,336.64 ",100% of Healthchoice DRG rate,"$21,470.98 ",90% of billed charges for inpatient setting,"$22,186.68 ",93% of billed charges for inpatient setting ,"$4,335.63 ",102% of Medicaid DRG rate,"$4,293.13 ",101% of Medicaid DRG rate,"$20,278.14 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$21,470.98 ",90%of billed charges for inpatient setting,"$4,250.62 ",100% of Medicaid DRG rate,"$20,755.28 ",87% of billed charges for inpatient setting,"$4,250.62 ",100% of Medicaid DRG rate,"$7,674.57 ",Pays at 100% of Medicaid IPPS rate,"$16,699.65 ",70% of billed charges for inpatient setting,"$2,263.16 ","$22,186.68 ","$19,085.31 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,682,Renal Failure w/MCC,100,"$43,115.13 ","$7,539.33 ",Pays at 100% of Medicaid DRG rate ,"$12,975.83 ",100% of BCBS DRG rate ,"$34,492.10 ",80% of billed charges for inpatient setting,"$16,090.96 ",100% of Healthchoice DRG rate,"$38,803.62 ",90% of billed charges for inpatient setting,"$40,097.07 ",93% of billed charges for inpatient setting ,"$7,690.12 ",102% of Medicaid DRG rate,"$7,614.72 ",101% of Medicaid DRG rate,"$36,647.86 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$38,803.62 ",90%of billed charges for inpatient setting,"$7,539.33 ",100% of Medicaid DRG rate,"$37,510.16 ",87% of billed charges for inpatient setting,"$7,539.33 ",100% of Medicaid DRG rate,"$14,740.18 ",Pays at 100% of Medicaid IPPS rate,"$30,180.59 ",70% of billed charges for inpatient setting,"$2,263.16 ","$40,097.07 ","$34,492.10 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,785,Cesarean Section w/Sterilization w/o CC/MCC,100,"$32,029.90 ","$4,458.99 ",Pays at 100% of Medicaid DRG rate ,"$7,050.62 ",100% of BCBS DRG rate ,"$25,623.92 ",80% of billed charges for inpatient setting,"$9,872.57 ",100% of Healthchoice DRG rate,"$28,826.91 ",90% of billed charges for inpatient setting,"$29,787.81 ",93% of billed charges for inpatient setting ,"$4,548.17 ",102% of Medicaid DRG rate,"$4,503.58 ",101% of Medicaid DRG rate,"$27,225.42 ",85%of billed charges for inpatient setting,"$28,826.91 ",90% of billed charges for inpatient setting,"$28,826.91 ",90%of billed charges for inpatient setting,"$4,458.99 ",100% of Medicaid DRG rate,"$27,866.01 ",87% of billed charges for inpatient setting,"$4,458.99 ",100% of Medicaid DRG rate,"$8,508.41 ",Pays at 100% of Medicaid IPPS rate,"$22,420.93 ",70% of billed charges for inpatient setting,"$4,458.99 ","$29,787.81 ","$25,623.92 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,786,Cesarean Section w/o Sterilization w/MCC,100,"$34,870.01 ","$7,601.97 ",Pays at 100% of Medicaid DRG rate ,"$12,965.48 ",100% of BCBS DRG rate ,"$27,896.01 ",80% of billed charges for inpatient setting,"$17,480.76 ",100% of Healthchoice DRG rate,"$31,383.01 ",90% of billed charges for inpatient setting,"$32,429.11 ",93% of billed charges for inpatient setting ,"$7,754.01 ",102% of Medicaid DRG rate,"$7,677.99 ",101% of Medicaid DRG rate,"$29,639.51 ",85%of billed charges for inpatient setting,"$31,383.01 ",90% of billed charges for inpatient setting,"$31,383.01 ",90%of billed charges for inpatient setting,"$7,601.97 ",100% of Medicaid DRG rate,"$30,336.91 ",87% of billed charges for inpatient setting,"$7,601.97 ",100% of Medicaid DRG rate,"$17,182.81 ",Pays at 100% of Medicaid IPPS rate,"$24,409.01 ",70% of billed charges for inpatient setting,"$7,601.97 ","$32,429.11 ","$27,896.01 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,787,Cesarean Section w/o Sterilization w/CC,100,"$30,667.58 ","$5,054.80 ",Pays at 100% of Medicaid DRG rate ,"$9,015.29 ",100% of BCBS DRG rate ,"$24,534.06 ",80% of billed charges for inpatient setting,"$11,530.81 ",100% of Healthchoice DRG rate,"$27,600.82 ",90% of billed charges for inpatient setting,"$28,520.85 ",93% of billed charges for inpatient setting ,"$5,155.90 ",102% of Medicaid DRG rate,"$5,105.35 ",101% of Medicaid DRG rate,"$26,067.44 ",85%of billed charges for inpatient setting,"$27,600.82 ",90% of billed charges for inpatient setting,"$27,600.82 ",90%of billed charges for inpatient setting,"$5,054.80 ",100% of Medicaid DRG rate,"$26,680.79 ",87% of billed charges for inpatient setting,"$5,054.80 ",100% of Medicaid DRG rate,"$10,323.44 ",Pays at 100% of Medicaid IPPS rate,"$21,467.31 ",70% of billed charges for inpatient setting,"$5,054.80 ","$28,520.85 ","$24,534.06 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,788,Cesarean Section w/o Sterilization w/o CC/MCC,100,"$27,806.77 ","$4,386.57 ",Pays at 100% of Medicaid DRG rate ,"$7,510.94 ",100% of BCBS DRG rate ,"$22,245.42 ",80% of billed charges for inpatient setting,"$9,442.86 ",100% of Healthchoice DRG rate,"$25,026.09 ",90% of billed charges for inpatient setting,"$25,860.30 ",93% of billed charges for inpatient setting ,"$4,474.30 ",102% of Medicaid DRG rate,"$4,430.44 ",101% of Medicaid DRG rate,"$23,635.75 ",85%of billed charges for inpatient setting,"$25,026.09 ",90% of billed charges for inpatient setting,"$25,026.09 ",90%of billed charges for inpatient setting,"$4,386.57 ",100% of Medicaid DRG rate,"$24,191.89 ",87% of billed charges for inpatient setting,"$4,386.57 ",100% of Medicaid DRG rate,"$8,397.44 ",Pays at 100% of Medicaid IPPS rate,"$19,464.74 ",70% of billed charges for inpatient setting,"$4,386.57 ","$25,860.30 ","$22,245.42 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,792,Newborn Prematurity w/o Major Problems,100,"$16,441.33 ",N/A,Not separately reimbursable per CMS guidelines,"$11,204.48 ",100% of BCBS DRG rate ,"$13,153.06 ",80% of billed charges for inpatient setting,"$26,856.51 ",100% of Healthchoice DRG rate,"$14,797.20 ",90% of billed charges for inpatient setting,"$15,290.44 ",93% of billed charges for inpatient setting ,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$13,975.13 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$14,797.20 ",90%of billed charges for inpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$14,303.96 ",87% of billed charges for inpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$24,283.80 ",Pays at 100% of Medicaid IPPS rate,"$11,508.93 ",70% of billed charges for inpatient setting,"$2,263.16 ","$26,856.51 ","$13,153.06 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,793,Newborn Neonate Full Term w/Major Feeding Problems,100,"$3,649.18 ","$6,697.82 ",Pays at 100% of Medicaid DRG rate ,"$33,196.88 ",100% of BCBS DRG rate ,"$2,919.34 ",80% of billed charges for inpatient setting,"$45,720.58 ",100% of Healthchoice DRG rate,"$3,284.26 ",90% of billed charges for inpatient setting,"$3,393.74 ",93% of billed charges for inpatient setting ,"$6,831.78 ",102% of Medicaid DRG rate,"$6,764.80 ",101% of Medicaid DRG rate,"$3,101.80 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$3,284.26 ",90%of billed charges for inpatient setting,"$6,697.82 ",100% of Medicaid DRG rate,"$3,174.79 ",87% of billed charges for inpatient setting,"$6,697.82 ",100% of Medicaid DRG rate,"$41,341.88 ",Pays at 100% of Medicaid IPPS rate,"$2,554.43 ",70% of billed charges for inpatient setting,"$2,263.16 ","$45,720.58 ","$2,919.34 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,794,Newborn Neonate w/other Significantt Problems,100,"$7,730.02 ","$1,786.97 ",Pays at 100% of Medicaid DRG rate ,"$11,668.21 ",100% of BCBS DRG rate ,"$6,184.02 ",80% of billed charges for inpatient setting,"$16,182.96 ",100% of Healthchoice DRG rate,"$6,957.02 ",90% of billed charges for inpatient setting,"$7,188.92 ",93% of billed charges for inpatient setting ,"$1,822.71 ",102% of Medicaid DRG rate,"$1,804.84 ",101% of Medicaid DRG rate,"$6,570.52 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$6,957.02 ",90%of billed charges for inpatient setting,"$1,786.97 ",100% of Medicaid DRG rate,"$6,725.12 ",87% of billed charges for inpatient setting,"$1,786.97 ",100% of Medicaid DRG rate,"$14,633.14 ",Pays at 100% of Medicaid IPPS rate,"$5,411.01 ",70% of billed charges for inpatient setting,"$1,786.97 ","$16,182.96 ","$6,184.02 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,795,Newborn Normal,100,"$4,968.57 ",$894.38 ,Pays at 100% of Medicaid DRG rate ,"$1,381.38 ",100% of BCBS DRG rate ,"$3,974.86 ",80% of billed charges for inpatient setting,"$2,190.78 ",100% of Healthchoice DRG rate,"$4,471.71 ",90% of billed charges for inpatient setting,"$4,620.77 ",93% of billed charges for inpatient setting ,$912.27 ,102% of Medicaid DRG rate,$903.32 ,101% of Medicaid DRG rate,"$4,223.28 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$4,471.71 ",90%of billed charges for inpatient setting,$894.38 ,100% of Medicaid DRG rate,"$4,322.66 ",87% of billed charges for inpatient setting,$894.38 ,100% of Medicaid DRG rate,"$2,360.47 ",Pays at 100% of Medicaid IPPS rate,"$3,478.00 ",70% of billed charges for inpatient setting,$894.38 ,"$4,620.77 ","$3,974.86 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,798,Vaginal Delivery w/Sterilization and/or D&C w/o CC/MCC,100,"$27,142.10 ","$4,654.93 ",Pays at 100% of Medicaid DRG rate ,"$7,062.30 ",100% of BCBS DRG rate ,"$21,713.68 ",80% of billed charges for inpatient setting,"$10,043.59 ",100% of Healthchoice DRG rate,"$24,427.89 ",90% of billed charges for inpatient setting,"$25,242.15 ",93% of billed charges for inpatient setting ,"$4,748.03 ",102% of Medicaid DRG rate,"$4,701.48 ",101% of Medicaid DRG rate,"$23,070.79 ",85%of billed charges for inpatient setting,"$24,427.89 ",90% of billed charges for inpatient setting,"$24,427.89 ",90%of billed charges for inpatient setting,"$4,654.93 ",100% of Medicaid DRG rate,"$23,613.63 ",87% of billed charges for inpatient setting,"$4,654.93 ",100% of Medicaid DRG rate,"$8,201.98 ",Pays at 100% of Medicaid IPPS rate,"$18,999.47 ",70% of billed charges for inpatient setting,"$4,654.93 ","$25,242.15 ","$21,713.68 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,805,Vaginal Delivery w/o Sterilization or D&C w/MCC,100,"$18,624.33 ","$4,419.01 ",Pays at 100% of Medicaid DRG rate ,"$10,665.58 ",100% of BCBS DRG rate ,"$14,899.46 ",80% of billed charges for inpatient setting,"$10,884.61 ",100% of Healthchoice DRG rate,"$16,761.90 ",90% of billed charges for inpatient setting,"$17,320.63 ",93% of billed charges for inpatient setting ,"$4,507.39 ",102% of Medicaid DRG rate,"$4,463.20 ",101% of Medicaid DRG rate,"$15,830.68 ",85%of billed charges for inpatient setting,"$16,761.90 ",90% of billed charges for inpatient setting,"$16,761.90 ",90%of billed charges for inpatient setting,"$4,419.01 ",100% of Medicaid DRG rate,"$16,203.17 ",87% of billed charges for inpatient setting,"$4,419.01 ",100% of Medicaid DRG rate,"$9,902.09 ",Pays at 100% of Medicaid IPPS rate,"$13,037.03 ",70% of billed charges for inpatient setting,"$4,419.01 ","$17,320.63 ","$14,899.46 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,806,Vaginal Delivery w/o Sterilization or D&C w/CC,100,"$13,196.78 ","$3,589.06 ",Pays at 100% of Medicaid DRG rate ,"$7,373.76 ",100% of BCBS DRG rate ,"$10,557.42 ",80% of billed charges for inpatient setting,"$7,552.99 ",100% of Healthchoice DRG rate,"$11,877.10 ",90% of billed charges for inpatient setting,"$12,273.01 ",93% of billed charges for inpatient setting ,"$3,660.84 ",102% of Medicaid DRG rate,"$3,624.95 ",101% of Medicaid DRG rate,"$11,217.26 ",85%of billed charges for inpatient setting,"$11,877.10 ",90% of billed charges for inpatient setting,"$11,877.10 ",90%of billed charges for inpatient setting,"$3,589.06 ",100% of Medicaid DRG rate,"$11,481.20 ",87% of billed charges for inpatient setting,"$3,589.06 ",100% of Medicaid DRG rate,"$7,333.75 ",Pays at 100% of Medicaid IPPS rate,"$9,237.75 ",70% of billed charges for inpatient setting,"$3,589.06 ","$12,273.01 ","$10,557.42 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,807,Vaginal Delivery w/o Sterilization or D&C w/o CC/MCC,100,"$12,075.54 ","$3,068.34 ",Pays at 100% of Medicaid DRG rate ,"$5,120.15 ",100% of BCBS DRG rate ,"$9,660.43 ",80% of billed charges for inpatient setting,"$6,834.27 ",100% of Healthchoice DRG rate,"$10,867.99 ",90% of billed charges for inpatient setting,"$11,230.25 ",93% of billed charges for inpatient setting ,"$3,129.71 ",102% of Medicaid DRG rate,"$3,099.02 ",101% of Medicaid DRG rate,"$10,264.21 ",85%of billed charges for inpatient setting,"$10,867.99 ",90% of billed charges for inpatient setting,"$10,867.99 ",90%of billed charges for inpatient setting,"$3,068.34 ",100% of Medicaid DRG rate,"$10,505.72 ",87% of billed charges for inpatient setting,"$3,068.34 ",100% of Medicaid DRG rate,"$6,426.24 ",Pays at 100% of Medicaid IPPS rate,"$8,452.88 ",70% of billed charges for inpatient setting,"$3,068.34 ","$11,230.25 ","$9,660.43 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,853,Infectious and Parasitic Diseases w/ Op Room Procedures w/MCC,100,"$108,017.75 ","$32,637.39 ",Pays at 100% of Medicaid DRG rate ,"$33,412.60 ",100% of BCBS DRG rate ,"$86,414.20 ",80% of billed charges for inpatient setting,"$53,048.42 ",100% of Healthchoice DRG rate,"$97,215.98 ",90% of billed charges for inpatient setting,"$100,456.51 ",93% of billed charges for inpatient setting ,"$33,290.14 ",102% of Medicaid DRG rate,"$32,963.76 ",101% of Medicaid DRG rate,"$91,815.09 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$97,215.98 ",90%of billed charges for inpatient setting,"$32,637.39 ",100% of Medicaid DRG rate,"$93,975.44 ",87% of billed charges for inpatient setting,"$32,637.39 ",100% of Medicaid DRG rate,"$49,100.91 ",Pays at 100% of Medicaid IPPS rate,"$75,612.43 ",70% of billed charges for inpatient setting,"$3,487.92 ","$100,456.51 ","$86,414.20 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,854,Infectious and Parasitic Diseases w/ Op Room Procedures w/CC,100,"$53,604.61 ","$10,472.15 ",Pays at 100% of Medicaid DRG rate ,"$13,929.20 ",100% of BCBS DRG rate ,"$42,883.69 ",80% of billed charges for inpatient setting,"$22,249.81 ",100% of Healthchoice DRG rate,"$48,244.15 ",90% of billed charges for inpatient setting,"$49,852.29 ",93% of billed charges for inpatient setting ,"$10,681.59 ",102% of Medicaid DRG rate,"$10,576.87 ",101% of Medicaid DRG rate,"$45,563.92 ",85%of billed charges for inpatient setting,"$3,487.92 ",per diems,"$48,244.15 ",90%of billed charges for inpatient setting,"$10,472.15 ",100% of Medicaid DRG rate,"$46,636.01 ",87% of billed charges for inpatient setting,"$10,472.15 ",100% of Medicaid DRG rate,"$20,018.29 ",Pays at 100% of Medicaid IPPS rate,"$37,523.23 ",70% of billed charges for inpatient setting,"$3,487.92 ","$49,852.29 ","$42,883.69 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,871,Septicemia or Severe Sepsis w/o MV >96 hours w/MCC,100,"$37,934.83 ","$10,954.22 ",Pays at 100% of Medicaid DRG rate ,"$15,888.19 ",100% of BCBS DRG rate ,"$30,347.86 ",80% of billed charges for inpatient setting,"$21,184.73 ",100% of Healthchoice DRG rate,"$34,141.35 ",90% of billed charges for inpatient setting,"$35,279.39 ",93% of billed charges for inpatient setting ,"$11,173.30 ",102% of Medicaid DRG rate,"$11,063.76 ",101% of Medicaid DRG rate,"$32,244.61 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$34,141.35 ",90%of billed charges for inpatient setting,"$10,954.22 ",100% of Medicaid DRG rate,"$33,003.30 ",87% of billed charges for inpatient setting,"$10,954.22 ",100% of Medicaid DRG rate,"$19,472.23 ",Pays at 100% of Medicaid IPPS rate,"$26,554.38 ",70% of billed charges for inpatient setting,"$2,263.16 ","$35,279.39 ","$30,347.86 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,Inpatient Procedures,872,Septicemia or Severe Sepsis w/o MV >96 hours w/o MCC,100,"$27,362.92 ","$4,898.85 ",Pays at 100% of Medicaid DRG rate ,"$9,101.52 ",100% of BCBS DRG rate ,"$21,890.34 ",80% of billed charges for inpatient setting,"$11,127.07 ",100% of Healthchoice DRG rate,"$24,626.63 ",90% of billed charges for inpatient setting,"$25,447.52 ",93% of billed charges for inpatient setting ,"$4,996.83 ",102% of Medicaid DRG rate,"$4,947.84 ",101% of Medicaid DRG rate,"$23,258.48 ",85%of billed charges for inpatient setting,"$2,263.16 ",per diems,"$24,626.63 ",90%of billed charges for inpatient setting,"$4,898.85 ",100% of Medicaid DRG rate,"$23,805.74 ",87% of billed charges for inpatient setting,"$4,898.85 ",100% of Medicaid DRG rate,"$10,115.23 ",Pays at 100% of Medicaid IPPS rate,"$19,154.04 ",70% of billed charges for inpatient setting,"$2,263.16 ","$25,447.52 ","$21,890.34 ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99203,"New patient office or other outpatient visit, typically 30 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99204,"New patient office of other outpatient visit, typically 45 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99205,"New patient office of other outpatient visit, typically 60 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LAB,80069,Kidney function panel tes,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,