hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WV,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,
Mon Health Marion Neighborhood Hospital,2024-09-11,2.0.0,Mon Health Marion Neighborhood Hospital,"1200 J D Anderson Dr Morgantown, WV 26505",174,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA COMMERCIAL PLAN,AETNA COMMERCIAL REIMBURSEMENT METHOD,AETNA MEDICAL RENTAL PLAN,AETNA MEDICAL RENTAL REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,CARESOURCE MEDICAID PLAN,CARESOURCE MEDICAID REIMBURSEMENT METHOD,CARESOURCE WV MARKETPLACE PLAN,CARESOURCE WV MARKETPLACE REIMBURSEMENT METHOD,CHIP PLAN,CHIP REIMBURSEMENT METHOD,HIGHMARK ACA PLAN,HIGHMARK ACA REIMBURSEMENT METHOD,HIGHMARK PPO POS FEP PLAN,HIGHMARK PPO POS FEP REIMBURSEMENT METHOD,HIGHMARK TRADITIONAL PLAN,HIGHMARK TRADITIONAL REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,PEIA PLAN,PEIA REIMBURSEMENT METHOD,THE HEALTH PLAN COMMERCIAL PLAN,THE HEALTH PLAN COMMERCIAL REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,LAB,80048,Basic metabolic panel,300,174.72,131.04,75% of Total billed charges,131.04,75% of Total billed charges,8.46,100% of CMS OPPS Rate,7.61,100% of Medicaid Fee Schedule,8.46,100% of CMS OPPS Rate,8.46,100% of CMS OPPS RATE ,29.99,354.54% OF CMS OPPS RATE,36.26,428.7% of CMS OPPS Rate,38.13,450.81% of CMS OPPS Rate,7.61,100% of WV Medicaid Fee Schedule,8.46,100% of CMS OPPS Rate,8.46,100% of CMS OPPS Rate,24.46,14% of Total Billed Charges,7.61,131.04,87.36
Outpatient Medical Services,LAB,80048,Basic metabolic panel,300,174.72,131.04,75% of Total billed charges,131.04,75% of Total billed charges,8.46,100% of CMS OPPS Rate,7.61,100% of Medicaid Fee Schedule,8.46,100% of CMS OPPS Rate,8.46,100% of CMS OPPS RATE ,29.99,354.54% OF CMS OPPS RATE,36.26,428.7% of CMS OPPS Rate,38.13,450.81% of CMS OPPS Rate,7.61,100% of WV Medicaid Fee Schedule,8.46,100% of CMS OPPS Rate,8.46,100% of CMS OPPS Rate,24.46,14% of Total Billed Charges,7.61,131.04,87.36
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",300,265.44,199.08,75% of Total billed charges,199.08,75% of Total billed charges,10.56,100% of CMS OPPS Rate,9.5,100% of Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS RATE ,37.43,354.54% OF CMS OPPS RATE,45.27,428.7% of CMS OPPS Rate,47.6,450.81% of CMS OPPS Rate,9.5,100% of WV Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS Rate,37.16,14% of Total Billed Charges,9.5,199.08,132.72
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",300,265.44,199.08,75% of Total billed charges,199.08,75% of Total billed charges,10.56,100% of CMS OPPS Rate,9.5,100% of Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS RATE ,37.43,354.54% OF CMS OPPS RATE,45.27,428.7% of CMS OPPS Rate,47.6,450.81% of CMS OPPS Rate,9.5,100% of WV Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS Rate,37.16,14% of Total Billed Charges,9.5,199.08,132.72
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",300,33.6,25.2,75% of Total billed charges,25.2,75% of Total billed charges,10.56,100% of CMS OPPS Rate,9.5,100% of Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS RATE ,37.43,354.54% OF CMS OPPS RATE,45.27,428.7% of CMS OPPS Rate,47.6,450.81% of CMS OPPS Rate,9.5,100% of WV Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS Rate,4.7,14% of Total Billed Charges,4.7,47.6,16.80
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",300,22.96,17.22,75% of Total billed charges,17.22,75% of Total billed charges,10.56,100% of CMS OPPS Rate,9.5,100% of Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS RATE ,37.43,354.54% OF CMS OPPS RATE,45.27,428.7% of CMS OPPS Rate,47.6,450.81% of CMS OPPS Rate,9.5,100% of WV Medicaid Fee Schedule,10.56,100% of CMS OPPS Rate,10.56,100% of CMS OPPS Rate,3.21,14% of Total Billed Charges,3.21,47.6,11.48
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,209.44,157.08,75% of Total billed charges,157.08,75% of Total billed charges,47.81,100% of CMS OPPS Rate,43.03,100% of Medicaid Fee Schedule,47.81,100% of CMS OPPS Rate,47.81,100% of CMS OPPS RATE ,169.5,354.54% OF CMS OPPS RATE,204.96,428.7% of CMS OPPS Rate,215.53,450.81% of CMS OPPS Rate,43.03,100% of WV Medicaid Fee Schedule,47.81,100% of CMS OPPS Rate,47.81,100% of CMS OPPS Rate,29.32,14% of Total Billed Charges,29.32,215.53,104.72
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",300,16.8,12.6,75% of Total billed charges,12.6,75% of Total billed charges,13.39,100% of CMS OPPS Rate,12.05,100% of Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS RATE ,47.47,354.54% OF CMS OPPS RATE,57.4,428.7% of CMS OPPS Rate,60.36,450.81% of CMS OPPS Rate,12.05,100% of WV Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS Rate,2.35,14% of Total Billed Charges,2.35,60.36,8.40
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",300,16.8,12.6,75% of Total billed charges,12.6,75% of Total billed charges,13.39,100% of CMS OPPS Rate,12.05,100% of Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS RATE ,47.47,354.54% OF CMS OPPS RATE,57.4,428.7% of CMS OPPS Rate,60.36,450.81% of CMS OPPS Rate,12.05,100% of WV Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS Rate,2.35,14% of Total Billed Charges,2.35,60.36,8.40
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",300,147.84,110.88,75% of Total billed charges,110.88,75% of Total billed charges,13.39,100% of CMS OPPS Rate,12.05,100% of Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS RATE ,47.47,354.54% OF CMS OPPS RATE,57.4,428.7% of CMS OPPS Rate,60.36,450.81% of CMS OPPS Rate,12.05,100% of WV Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS Rate,20.7,14% of Total Billed Charges,12.05,110.88,73.92
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",300,85.12,63.84,75% of Total billed charges,63.84,75% of Total billed charges,13.39,100% of CMS OPPS Rate,12.05,100% of Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS RATE ,47.47,354.54% OF CMS OPPS RATE,57.4,428.7% of CMS OPPS Rate,60.36,450.81% of CMS OPPS Rate,12.05,100% of WV Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS Rate,11.92,14% of Total Billed Charges,11.92,63.84,42.56
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",300,95.16,71.37,75% of Total billed charges,71.37,75% of Total billed charges,13.39,100% of CMS OPPS Rate,12.05,100% of Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS RATE ,47.47,354.54% OF CMS OPPS RATE,57.4,428.7% of CMS OPPS Rate,60.36,450.81% of CMS OPPS Rate,12.05,100% of WV Medicaid Fee Schedule,13.39,100% of CMS OPPS Rate,13.39,100% of CMS OPPS Rate,13.32,14% of Total Billed Charges,12.05,71.37,47.58
Outpatient Medical Services,LAB,80069,Kidney function panel test,300,181.44,136.08,75% of Total billed charges,136.08,75% of Total billed charges,8.68,100% of CMS OPPS Rate,7.81,100% of Medicaid Fee Schedule,8.68,100% of CMS OPPS Rate,8.68,100% of CMS OPPS RATE ,30.77,354.54% OF CMS OPPS RATE,37.21,428.7% of CMS OPPS Rate,39.13,450.81% of CMS OPPS Rate,7.81,100% of WV Medicaid Fee Schedule,8.68,100% of CMS OPPS Rate,8.68,100% of CMS OPPS Rate,25.4,14% of Total Billed Charges,7.81,136.08,90.72
Outpatient Medical Services,LAB,80069,Kidney function panel test,300,181.44,136.08,75% of Total billed charges,136.08,75% of Total billed charges,8.68,100% of CMS OPPS Rate,7.81,100% of Medicaid Fee Schedule,8.68,100% of CMS OPPS Rate,8.68,100% of CMS OPPS RATE ,30.77,354.54% OF CMS OPPS RATE,37.21,428.7% of CMS OPPS Rate,39.13,450.81% of CMS OPPS Rate,7.81,100% of WV Medicaid Fee Schedule,8.68,100% of CMS OPPS Rate,8.68,100% of CMS OPPS Rate,25.4,14% of Total Billed Charges,7.81,136.08,90.72
Outpatient Medical Services,LAB,80076,Liver function blood test panel,300,155.68,116.76,75% of Total billed charges,116.76,75% of Total billed charges,8.17,100% of CMS OPPS Rate,7.35,100% of Medicaid Fee Schedule,8.17,100% of CMS OPPS Rate,8.17,100% of CMS OPPS RATE ,28.96,354.54% OF CMS OPPS RATE,35.02,428.7% of CMS OPPS Rate,36.83,450.81% of CMS OPPS Rate,7.35,100% of WV Medicaid Fee Schedule,8.17,100% of CMS OPPS Rate,8.17,100% of CMS OPPS Rate,21.8,14% of Total Billed Charges,7.35,116.76,77.84
Outpatient Medical Services,LAB,80076,Liver function blood test panel,300,155.68,116.76,75% of Total billed charges,116.76,75% of Total billed charges,8.17,100% of CMS OPPS Rate,7.35,100% of Medicaid Fee Schedule,8.17,100% of CMS OPPS Rate,8.17,100% of CMS OPPS RATE ,28.96,354.54% OF CMS OPPS RATE,35.02,428.7% of CMS OPPS Rate,36.83,450.81% of CMS OPPS Rate,7.35,100% of WV Medicaid Fee Schedule,8.17,100% of CMS OPPS Rate,8.17,100% of CMS OPPS Rate,21.8,14% of Total Billed Charges,7.35,116.76,77.84
Outpatient Medical Services,LAB,80162,Digoxin Level,300,174.72,131.04,75% of Total billed charges,131.04,75% of Total billed charges,13.28,100% of CMS OPPS Rate,11.95,100% of Medicaid Fee Schedule,13.28,100% of CMS OPPS Rate,13.28,100% of CMS OPPS RATE ,47.08,354.54% OF CMS OPPS RATE,56.93,428.7% of CMS OPPS Rate,59.86,450.81% of CMS OPPS Rate,11.95,100% of WV Medicaid Fee Schedule,13.28,100% of CMS OPPS Rate,13.28,100% of CMS OPPS Rate,24.46,14% of Total Billed Charges,11.95,131.04,87.36
Outpatient Medical Services,LAB,80164,Valproic Acid Level,300,155.68,116.76,75% of Total billed charges,116.76,75% of Total billed charges,13.54,100% of CMS OPPS Rate,12.19,100% of Medicaid Fee Schedule,13.54,100% of CMS OPPS Rate,13.54,100% of CMS OPPS RATE ,48,354.54% OF CMS OPPS RATE,58.04,428.7% of CMS OPPS Rate,61.03,450.81% of CMS OPPS Rate,12.19,100% of WV Medicaid Fee Schedule,13.54,100% of CMS OPPS Rate,13.54,100% of CMS OPPS Rate,21.8,14% of Total Billed Charges,12.19,116.76,77.84
Outpatient Medical Services,LAB,80178,"Lithium Level, SO",300,66.08,49.56,75% of Total billed charges,49.56,75% of Total billed charges,6.61,100% of CMS OPPS Rate,5.95,100% of Medicaid Fee Schedule,6.61,100% of CMS OPPS Rate,6.61,100% of CMS OPPS RATE ,23.43,354.54% OF CMS OPPS RATE,28.33,428.7% of CMS OPPS Rate,29.79,450.81% of CMS OPPS Rate,5.95,100% of WV Medicaid Fee Schedule,6.61,100% of CMS OPPS Rate,6.61,100% of CMS OPPS Rate,9.25,14% of Total Billed Charges,5.95,49.56,33.04
Outpatient Medical Services,LAB,80184,"Phenobarbital Level, SO",300,89.6,67.2,75% of Total billed charges,67.2,75% of Total billed charges,15.3,100% of CMS OPPS Rate,13.77,100% of Medicaid Fee Schedule,15.3,100% of CMS OPPS Rate,15.3,100% of CMS OPPS RATE ,54.24,354.54% OF CMS OPPS RATE,65.59,428.7% of CMS OPPS Rate,68.97,450.81% of CMS OPPS Rate,13.77,100% of WV Medicaid Fee Schedule,15.3,100% of CMS OPPS Rate,15.3,100% of CMS OPPS Rate,12.54,14% of Total Billed Charges,12.54,68.97,44.80
Outpatient Medical Services,LAB,80185,Dilantin Level,300,163.52,122.64,75% of Total billed charges,122.64,75% of Total billed charges,13.25,100% of CMS OPPS Rate,11.93,100% of Medicaid Fee Schedule,13.25,100% of CMS OPPS Rate,13.25,100% of CMS OPPS RATE ,46.97,354.54% OF CMS OPPS RATE,56.8,428.7% of CMS OPPS Rate,59.73,450.81% of CMS OPPS Rate,11.93,100% of WV Medicaid Fee Schedule,13.25,100% of CMS OPPS Rate,13.25,100% of CMS OPPS Rate,22.89,14% of Total Billed Charges,11.93,122.64,81.76
Outpatient Medical Services,LAB,80197,Test is used to measure the amount of the drug in the blood to determine whether the concentration has reached a therapeutic level and is below the to,300,176.96,132.72,75% of Total billed charges,132.72,75% of Total billed charges,13.73,100% of CMS OPPS Rate,12.36,100% of Medicaid Fee Schedule,13.73,100% of CMS OPPS Rate,13.73,100% of CMS OPPS RATE ,48.67,354.54% OF CMS OPPS RATE,58.86,428.7% of CMS OPPS Rate,61.89,450.81% of CMS OPPS Rate,12.36,100% of WV Medicaid Fee Schedule,13.73,100% of CMS OPPS Rate,13.73,100% of CMS OPPS Rate,24.77,14% of Total Billed Charges,12.36,132.72,88.48
Outpatient Medical Services,LAB,80198,"Theophylline Level, SO",300,91.84,68.88,75% of Total billed charges,68.88,75% of Total billed charges,14.14,100% of CMS OPPS Rate,12.73,100% of Medicaid Fee Schedule,14.14,100% of CMS OPPS Rate,14.14,100% of CMS OPPS RATE ,50.13,354.54% OF CMS OPPS RATE,60.61,428.7% of CMS OPPS Rate,63.74,450.81% of CMS OPPS Rate,12.73,100% of WV Medicaid Fee Schedule,14.14,100% of CMS OPPS Rate,14.14,100% of CMS OPPS Rate,12.86,14% of Total Billed Charges,12.73,68.88,45.92
Outpatient Medical Services,LAB,80202,Vancomycin Level Trough,300,159.04,119.28,75% of Total billed charges,119.28,75% of Total billed charges,13.54,100% of CMS OPPS Rate,12.19,100% of Medicaid Fee Schedule,13.54,100% of CMS OPPS Rate,13.54,100% of CMS OPPS RATE ,48,354.54% OF CMS OPPS RATE,58.04,428.7% of CMS OPPS Rate,61.03,450.81% of CMS OPPS Rate,12.19,100% of WV Medicaid Fee Schedule,13.54,100% of CMS OPPS Rate,13.54,100% of CMS OPPS Rate,22.27,14% of Total Billed Charges,12.19,119.28,79.52
Outpatient Medical Services,LAB,80305,Drug Screen,300,133.28,99.96,75% of Total billed charges,99.96,75% of Total billed charges,12.6,100% of CMS OPPS Rate,11.34,100% of Medicaid Fee Schedule,12.6,100% of CMS OPPS Rate,12.6,100% of CMS OPPS RATE ,44.67,354.54% OF CMS OPPS RATE,54.01,428.7% of CMS OPPS Rate,56.8,450.81% of CMS OPPS Rate,11.34,100% of WV Medicaid Fee Schedule,12.6,100% of CMS OPPS Rate,12.6,100% of CMS OPPS Rate,18.66,14% of Total Billed Charges,11.34,99.96,66.64
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,174.72,131.04,75% of Total billed charges,131.04,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,24.46,14% of Total Billed Charges,24.46,280.13,87.36
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,94.08,70.56,75% of Total billed charges,70.56,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,13.17,14% of Total Billed Charges,13.17,280.13,47.04
Outpatient Medical Services,LAB,80307,Testing for presence of drug,300,120.96,90.72,75% of Total billed charges,90.72,75% of Total billed charges,62.14,100% of CMS OPPS Rate,55.93,100% of Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS RATE ,220.31,354.54% OF CMS OPPS RATE,266.39,428.7% of CMS OPPS Rate,280.13,450.81% of CMS OPPS Rate,55.93,100% of WV Medicaid Fee Schedule,62.14,100% of CMS OPPS Rate,62.14,100% of CMS OPPS Rate,16.93,14% of Total Billed Charges,16.93,280.13,60.48
Outpatient Medical Services,LAB,80329,Acetaminophen Level,300,113.12,84.84,75% of Total billed charges,84.84,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,15.84,14% of Total Billed Charges,15.84,84.84,56.56
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination with or without using microscope,300,68.32,51.24,75% of Total billed charges,51.24,75% of Total billed charges,3.17,100% of CMS OPPS Rate,2.85,100% of Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS RATE ,11.23,354.54% OF CMS OPPS RATE,13.58,428.7% of CMS OPPS Rate,14.29,450.81% of CMS OPPS Rate,2.85,100% of WV Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS Rate,9.56,14% of Total Billed Charges,2.85,51.24,34.16
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination with or without using microscope,300,68.32,51.24,75% of Total billed charges,51.24,75% of Total billed charges,3.17,100% of CMS OPPS Rate,2.85,100% of Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS RATE ,11.23,354.54% OF CMS OPPS RATE,13.58,428.7% of CMS OPPS Rate,14.29,450.81% of CMS OPPS Rate,2.85,100% of WV Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS Rate,9.56,14% of Total Billed Charges,2.85,51.24,34.16
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination with or without using microscope,300,68.32,51.24,75% of Total billed charges,51.24,75% of Total billed charges,3.17,100% of CMS OPPS Rate,2.85,100% of Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS RATE ,11.23,354.54% OF CMS OPPS RATE,13.58,428.7% of CMS OPPS Rate,14.29,450.81% of CMS OPPS Rate,2.85,100% of WV Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS Rate,9.56,14% of Total Billed Charges,2.85,51.24,34.16
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination with or without using microscope,300,68.32,51.24,75% of Total billed charges,51.24,75% of Total billed charges,3.17,100% of CMS OPPS Rate,2.85,100% of Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS RATE ,11.23,354.54% OF CMS OPPS RATE,13.58,428.7% of CMS OPPS Rate,14.29,450.81% of CMS OPPS Rate,2.85,100% of WV Medicaid Fee Schedule,3.17,100% of CMS OPPS Rate,3.17,100% of CMS OPPS Rate,9.56,14% of Total Billed Charges,2.85,51.24,34.16
Outpatient Medical Services,LAB,81002,Manual urinalysis test with examination without using microscope,300,13.44,10.08,75% of Total billed charges,10.08,75% of Total billed charges,3.48,100% of CMS OPPS Rate,3.13,100% of Medicaid Fee Schedule,3.48,100% of CMS OPPS Rate,3.48,100% of CMS OPPS RATE ,12.33,354.54% OF CMS OPPS RATE,14.91,428.7% of CMS OPPS Rate,15.68,450.81% of CMS OPPS Rate,3.13,100% of WV Medicaid Fee Schedule,3.48,100% of CMS OPPS Rate,3.48,100% of CMS OPPS Rate,1.88,14% of Total Billed Charges,1.88,15.68,6.72
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,10.08,7.56,75% of Total billed charges,7.56,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,1.41,14% of Total Billed Charges,1.41,10.14,5.04
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,41.44,31.08,75% of Total billed charges,31.08,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,5.8,14% of Total Billed Charges,2.03,31.08,20.72
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,47.04,35.28,75% of Total billed charges,35.28,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,6.59,14% of Total Billed Charges,2.03,35.28,23.52
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,47.04,35.28,75% of Total billed charges,35.28,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,6.59,14% of Total Billed Charges,2.03,35.28,23.52
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,47.04,35.28,75% of Total billed charges,35.28,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,6.59,14% of Total Billed Charges,2.03,35.28,23.52
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,41.44,31.08,75% of Total billed charges,31.08,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,5.8,14% of Total Billed Charges,2.03,31.08,20.72
Outpatient Medical Services,LAB,81003,Automated urinalysis test,300,41.44,31.08,75% of Total billed charges,31.08,75% of Total billed charges,2.25,100% of CMS OPPS Rate,2.03,100% of Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS RATE ,7.97,354.54% OF CMS OPPS RATE,9.64,428.7% of CMS OPPS Rate,10.14,450.81% of CMS OPPS Rate,2.03,100% of WV Medicaid Fee Schedule,2.25,100% of CMS OPPS Rate,2.25,100% of CMS OPPS Rate,5.8,14% of Total Billed Charges,2.03,31.08,20.72
Outpatient Medical Services,LAB,82024,"Adrenocorticotropic Hormone, SO",300,248.64,186.48,75% of Total billed charges,186.48,75% of Total billed charges,38.61,100% of CMS OPPS Rate,34.76,100% of Medicaid Fee Schedule,38.61,100% of CMS OPPS Rate,38.62,100% of CMS OPPS RATE ,136.92,354.54% OF CMS OPPS RATE,165.56,428.7% of CMS OPPS Rate,174.1,450.81% of CMS OPPS Rate,34.76,100% of WV Medicaid Fee Schedule,38.61,100% of CMS OPPS Rate,38.62,100% of CMS OPPS Rate,34.81,14% of Total Billed Charges,34.76,186.48,124.32
Outpatient Medical Services,LAB,82140,"Ammonia, Level",300,152.32,114.24,75% of Total billed charges,114.24,75% of Total billed charges,14.57,100% of CMS OPPS Rate,13.11,100% of Medicaid Fee Schedule,14.57,100% of CMS OPPS Rate,14.57,100% of CMS OPPS RATE ,51.65,354.54% OF CMS OPPS RATE,62.46,428.7% of CMS OPPS Rate,65.68,450.81% of CMS OPPS Rate,13.11,100% of WV Medicaid Fee Schedule,14.57,100% of CMS OPPS Rate,14.57,100% of CMS OPPS Rate,21.32,14% of Total Billed Charges,13.11,114.24,76.16
Outpatient Medical Services,LAB,82150,Amylase,300,112,84,75% of Total billed charges,84,75% of Total billed charges,6.48,100% of CMS OPPS Rate,5.83,100% of Medicaid Fee Schedule,6.48,100% of CMS OPPS Rate,6.48,100% of CMS OPPS RATE ,22.97,354.54% OF CMS OPPS RATE,27.77,428.7% of CMS OPPS Rate,29.21,450.81% of CMS OPPS Rate,5.83,100% of WV Medicaid Fee Schedule,6.48,100% of CMS OPPS Rate,6.48,100% of CMS OPPS Rate,15.68,14% of Total Billed Charges,5.83,84,56.00
Outpatient Medical Services,LAB,82232,"Aldosterone, SO",300,229.6,172.2,75% of Total billed charges,172.2,75% of Total billed charges,16.18,100% of CMS OPPS Rate,14.56,100% of Medicaid Fee Schedule,16.18,100% of CMS OPPS Rate,16.18,100% of CMS OPPS RATE ,57.36,354.54% OF CMS OPPS RATE,69.36,428.7% of CMS OPPS Rate,72.94,450.81% of CMS OPPS Rate,14.56,100% of WV Medicaid Fee Schedule,16.18,100% of CMS OPPS Rate,16.18,100% of CMS OPPS Rate,32.14,14% of Total Billed Charges,14.56,172.2,114.80
Outpatient Medical Services,LAB,82247,Bilirubin Total,301,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,5.01,100% of CMS OPPS Rate,4.52,100% of Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS RATE ,17.79,354.54% OF CMS OPPS RATE,21.52,428.7% of CMS OPPS Rate,22.63,450.81% of CMS OPPS Rate,4.52,100% of WV Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.52,82.32,54.88
Outpatient Medical Services,LAB,82248,Measurement of direct bilirubin,301,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,5.01,100% of CMS OPPS Rate,4.52,100% of Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS RATE ,17.79,354.54% OF CMS OPPS RATE,21.52,428.7% of CMS OPPS Rate,22.63,450.81% of CMS OPPS Rate,4.52,100% of WV Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.52,82.32,54.88
Outpatient Medical Services,LAB,82248,Measurement of direct bilirubin,301,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,5.01,100% of CMS OPPS Rate,4.52,100% of Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS RATE ,17.79,354.54% OF CMS OPPS RATE,21.52,428.7% of CMS OPPS Rate,22.63,450.81% of CMS OPPS Rate,4.52,100% of WV Medicaid Fee Schedule,5.01,100% of CMS OPPS Rate,5.02,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.52,82.32,54.88
Outpatient Medical Services,LAB,82274,MC Occult Blood,300,66.08,49.56,75% of Total billed charges,49.56,75% of Total billed charges,15.92,100% of CMS OPPS Rate,14.33,100% of Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS RATE ,56.44,354.54% OF CMS OPPS RATE,68.24,428.7% of CMS OPPS Rate,71.76,450.81% of CMS OPPS Rate,14.33,100% of WV Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS Rate,9.25,14% of Total Billed Charges,9.25,71.76,33.04
Outpatient Medical Services,LAB,82274,MC Occult Blood Gastric,300,66.08,49.56,75% of Total billed charges,49.56,75% of Total billed charges,15.92,100% of CMS OPPS Rate,14.33,100% of Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS RATE ,56.44,354.54% OF CMS OPPS RATE,68.24,428.7% of CMS OPPS Rate,71.76,450.81% of CMS OPPS Rate,14.33,100% of WV Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS Rate,9.25,14% of Total Billed Charges,9.25,71.76,33.04
Outpatient Medical Services,LAB,82274,Occult Blood Diagnostic (FIT test),300,66.08,49.56,75% of Total billed charges,49.56,75% of Total billed charges,15.92,100% of CMS OPPS Rate,14.33,100% of Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS RATE ,56.44,354.54% OF CMS OPPS RATE,68.24,428.7% of CMS OPPS Rate,71.76,450.81% of CMS OPPS Rate,14.33,100% of WV Medicaid Fee Schedule,15.92,100% of CMS OPPS Rate,15.92,100% of CMS OPPS Rate,9.25,14% of Total Billed Charges,9.25,71.76,33.04
Outpatient Medical Services,LAB,82330,"Ionized Calcium, POC",300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,13.68,100% of CMS OPPS Rate,12.31,100% of Medicaid Fee Schedule,13.68,100% of CMS OPPS Rate,13.68,100% of CMS OPPS RATE ,48.5,354.54% OF CMS OPPS RATE,58.64,428.7% of CMS OPPS Rate,61.67,450.81% of CMS OPPS Rate,12.31,100% of WV Medicaid Fee Schedule,13.68,100% of CMS OPPS Rate,13.68,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,11.29,61.67,40.32
Outpatient Medical Services,LAB,82530,"Cortisol, SO",301,112,84,75% of Total billed charges,84,75% of Total billed charges,16.71,100% of CMS OPPS Rate,15.04,100% of Medicaid Fee Schedule,16.71,100% of CMS OPPS Rate,16.71,100% of CMS OPPS RATE ,59.24,354.54% OF CMS OPPS RATE,71.63,428.7% of CMS OPPS Rate,75.33,450.81% of CMS OPPS Rate,15.04,100% of WV Medicaid Fee Schedule,16.71,100% of CMS OPPS Rate,16.71,100% of CMS OPPS Rate,15.68,14% of Total Billed Charges,15.04,84,56.00
Outpatient Medical Services,LAB,82550,CK,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,6.51,100% of CMS OPPS Rate,5.86,100% of Medicaid Fee Schedule,6.51,100% of CMS OPPS Rate,6.51,100% of CMS OPPS RATE ,23.08,354.54% OF CMS OPPS RATE,27.9,428.7% of CMS OPPS Rate,29.34,450.81% of CMS OPPS Rate,5.86,100% of WV Medicaid Fee Schedule,6.51,100% of CMS OPPS Rate,6.51,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,5.86,82.32,54.88
Outpatient Medical Services,LAB,82565,Creatinine,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,5.12,100% of CMS OPPS Rate,4.61,100% of Medicaid Fee Schedule,5.12,100% of CMS OPPS Rate,5.12,100% of CMS OPPS RATE ,18.15,354.54% OF CMS OPPS RATE,21.94,428.7% of CMS OPPS Rate,23.08,450.81% of CMS OPPS Rate,4.61,100% of WV Medicaid Fee Schedule,5.12,100% of CMS OPPS Rate,5.12,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.61,82.32,54.88
Outpatient Medical Services,LAB,82565,Creatinine POC,300,125.44,94.08,75% of Total billed charges,94.08,75% of Total billed charges,5.12,100% of CMS OPPS Rate,4.61,100% of Medicaid Fee Schedule,5.12,100% of CMS OPPS Rate,5.12,100% of CMS OPPS RATE ,18.15,354.54% OF CMS OPPS RATE,21.94,428.7% of CMS OPPS Rate,23.08,450.81% of CMS OPPS Rate,4.61,100% of WV Medicaid Fee Schedule,5.12,100% of CMS OPPS Rate,5.12,100% of CMS OPPS Rate,17.56,14% of Total Billed Charges,4.61,94.08,62.72
Outpatient Medical Services,LAB,82570,Test to measure creatinine in the urine,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,5.18,100% of CMS OPPS Rate,4.66,100% of Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS RATE ,18.36,354.54% OF CMS OPPS RATE,22.2,428.7% of CMS OPPS Rate,23.35,450.81% of CMS OPPS Rate,4.66,100% of WV Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.66,82.32,54.88
Outpatient Medical Services,LAB,82607,Blood test to measure B-12,300,86.24,64.68,75% of Total billed charges,64.68,75% of Total billed charges,15.08,100% of CMS OPPS Rate,13.57,100% of Medicaid Fee Schedule,15.08,100% of CMS OPPS Rate,15.08,100% of CMS OPPS RATE ,53.46,354.54% OF CMS OPPS RATE,64.64,428.7% of CMS OPPS Rate,67.98,450.81% of CMS OPPS Rate,13.57,100% of WV Medicaid Fee Schedule,15.08,100% of CMS OPPS Rate,15.08,100% of CMS OPPS Rate,12.07,14% of Total Billed Charges,12.07,67.98,43.12
Outpatient Medical Services,LAB,82728,Test to determine level of iron in the blood,300,60.48,45.36,75% of Total billed charges,45.36,75% of Total billed charges,13.63,100% of CMS OPPS Rate,12.27,100% of Medicaid Fee Schedule,13.63,100% of CMS OPPS Rate,13.63,100% of CMS OPPS RATE ,48.32,354.54% OF CMS OPPS RATE,58.43,428.7% of CMS OPPS Rate,61.44,450.81% of CMS OPPS Rate,12.27,100% of WV Medicaid Fee Schedule,13.63,100% of CMS OPPS Rate,13.63,100% of CMS OPPS Rate,8.47,14% of Total Billed Charges,8.47,61.44,30.24
Outpatient Medical Services,LAB,82746,"Folate, Level",300,85.12,63.84,75% of Total billed charges,63.84,75% of Total billed charges,14.7,100% of CMS OPPS Rate,13.23,100% of Medicaid Fee Schedule,14.7,100% of CMS OPPS Rate,14.7,100% of CMS OPPS RATE ,52.11,354.54% OF CMS OPPS RATE,63.01,428.7% of CMS OPPS Rate,66.26,450.81% of CMS OPPS Rate,13.23,100% of WV Medicaid Fee Schedule,14.7,100% of CMS OPPS Rate,14.7,100% of CMS OPPS Rate,11.92,14% of Total Billed Charges,11.92,66.26,42.56
Outpatient Medical Services,LAB,82784,Test to determine levels of immunoglobulins in the blood,300,49.28,36.96,75% of Total billed charges,36.96,75% of Total billed charges,9.3,100% of CMS OPPS Rate,8.37,100% of Medicaid Fee Schedule,9.3,100% of CMS OPPS Rate,9.3,100% of CMS OPPS RATE ,32.97,354.54% OF CMS OPPS RATE,39.86,428.7% of CMS OPPS Rate,41.92,450.81% of CMS OPPS Rate,8.37,100% of WV Medicaid Fee Schedule,9.3,100% of CMS OPPS Rate,9.3,100% of CMS OPPS Rate,6.9,14% of Total Billed Charges,6.9,41.92,24.64
Outpatient Medical Services,LAB,82784,Test to determine levels of immunoglobulins in the blood,300,66.08,49.56,75% of Total billed charges,49.56,75% of Total billed charges,9.3,100% of CMS OPPS Rate,8.37,100% of Medicaid Fee Schedule,9.3,100% of CMS OPPS Rate,9.3,100% of CMS OPPS RATE ,32.97,354.54% OF CMS OPPS RATE,39.86,428.7% of CMS OPPS Rate,41.92,450.81% of CMS OPPS Rate,8.37,100% of WV Medicaid Fee Schedule,9.3,100% of CMS OPPS Rate,9.3,100% of CMS OPPS Rate,9.25,14% of Total Billed Charges,8.37,49.56,33.04
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,146.72,110.04,75% of Total billed charges,110.04,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,20.54,14% of Total Billed Charges,20.54,117.52,73.36
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,196,147,75% of Total billed charges,147,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,27.44,14% of Total Billed Charges,23.46,147,98.00
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,196,147,75% of Total billed charges,147,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,27.44,14% of Total Billed Charges,23.46,147,98.00
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,196,147,75% of Total billed charges,147,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,27.44,14% of Total Billed Charges,23.46,147,98.00
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,196,147,75% of Total billed charges,147,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,27.44,14% of Total Billed Charges,23.46,147,98.00
Outpatient Medical Services,LAB,82803,Test to measure arterial blood gases,300,125.44,94.08,75% of Total billed charges,94.08,75% of Total billed charges,26.07,100% of CMS OPPS Rate,23.46,100% of Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS RATE ,92.42,354.54% OF CMS OPPS RATE,111.76,428.7% of CMS OPPS Rate,117.52,450.81% of CMS OPPS Rate,23.46,100% of WV Medicaid Fee Schedule,26.07,100% of CMS OPPS Rate,26.07,100% of CMS OPPS Rate,17.56,14% of Total Billed Charges,17.56,117.52,62.72
Outpatient Medical Services,LAB,82945,Glucose Body Fluid,300,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,3.93,100% of CMS OPPS Rate,3.54,100% of Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS RATE ,13.93,354.54% OF CMS OPPS RATE,16.84,428.7% of CMS OPPS Rate,17.71,450.81% of CMS OPPS Rate,3.54,100% of WV Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,3.54,58.8,39.20
Outpatient Medical Services,LAB,82945,Glucose CSF,300,103.04,77.28,75% of Total billed charges,77.28,75% of Total billed charges,3.93,100% of CMS OPPS Rate,3.54,100% of Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS RATE ,13.93,354.54% OF CMS OPPS RATE,16.84,428.7% of CMS OPPS Rate,17.71,450.81% of CMS OPPS Rate,3.54,100% of WV Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS Rate,14.43,14% of Total Billed Charges,3.54,77.28,51.52
Outpatient Medical Services,LAB,82947,Quantitative measure of glucose build up in the blood over time,300,39.2,29.4,75% of Total billed charges,29.4,75% of Total billed charges,3.93,100% of CMS OPPS Rate,3.54,100% of Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS RATE ,13.93,354.54% OF CMS OPPS RATE,16.84,428.7% of CMS OPPS Rate,17.71,450.81% of CMS OPPS Rate,3.54,100% of WV Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS Rate,5.49,14% of Total Billed Charges,3.54,29.4,19.60
Outpatient Medical Services,LAB,82947,Quantitative measure of glucose build up in the blood over time,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,3.93,100% of CMS OPPS Rate,3.54,100% of Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS RATE ,13.93,354.54% OF CMS OPPS RATE,16.84,428.7% of CMS OPPS Rate,17.71,450.81% of CMS OPPS Rate,3.54,100% of WV Medicaid Fee Schedule,3.93,100% of CMS OPPS Rate,3.93,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,3.54,56.28,37.52
Outpatient Medical Services,LAB,82962,Glucose Capillary,300,39.2,29.4,75% of Total billed charges,29.4,75% of Total billed charges,3.28,100% of CMS OPPS Rate,2.95,100% of Medicaid Fee Schedule,3.28,100% of CMS OPPS Rate,3.28,100% of CMS OPPS RATE ,11.62,354.54% OF CMS OPPS RATE,14.06,428.7% of CMS OPPS Rate,14.78,450.81% of CMS OPPS Rate,2.95,100% of WV Medicaid Fee Schedule,3.28,100% of CMS OPPS Rate,3.28,100% of CMS OPPS Rate,5.49,14% of Total Billed Charges,2.95,29.4,19.60
Outpatient Medical Services,LAB,82962,Glucose Capillary IPU,300,39.2,29.4,75% of Total billed charges,29.4,75% of Total billed charges,3.28,100% of CMS OPPS Rate,2.95,100% of Medicaid Fee Schedule,3.28,100% of CMS OPPS Rate,3.28,100% of CMS OPPS RATE ,11.62,354.54% OF CMS OPPS RATE,14.06,428.7% of CMS OPPS Rate,14.78,450.81% of CMS OPPS Rate,2.95,100% of WV Medicaid Fee Schedule,3.28,100% of CMS OPPS Rate,3.28,100% of CMS OPPS Rate,5.49,14% of Total Billed Charges,2.95,29.4,19.60
Outpatient Medical Services,LAB,83036,Blood test to measure average blood glucose levels for past 2-3 months,300,57.12,42.84,75% of Total billed charges,42.84,75% of Total billed charges,9.71,100% of CMS OPPS Rate,8.74,100% of Medicaid Fee Schedule,9.71,100% of CMS OPPS Rate,9.71,100% of CMS OPPS RATE ,34.42,354.54% OF CMS OPPS RATE,41.62,428.7% of CMS OPPS Rate,43.77,450.81% of CMS OPPS Rate,8.74,100% of WV Medicaid Fee Schedule,9.71,100% of CMS OPPS Rate,9.71,100% of CMS OPPS Rate,8,14% of Total Billed Charges,8,43.77,28.56
Outpatient Medical Services,LAB,83605,Lactic Acid,300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,11.57,100% of CMS OPPS Rate,10.41,100% of Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS RATE ,41.02,354.54% OF CMS OPPS RATE,49.6,428.7% of CMS OPPS Rate,52.15,450.81% of CMS OPPS Rate,10.41,100% of WV Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,6.74,52.15,24.08
Outpatient Medical Services,LAB,83605,Lactic Acid (Art),300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,11.57,100% of CMS OPPS Rate,10.41,100% of Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS RATE ,41.02,354.54% OF CMS OPPS RATE,49.6,428.7% of CMS OPPS Rate,52.15,450.81% of CMS OPPS Rate,10.41,100% of WV Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,6.74,52.15,24.08
Outpatient Medical Services,LAB,83615,LDH,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,6.04,100% of CMS OPPS Rate,5.44,100% of Medicaid Fee Schedule,6.04,100% of CMS OPPS Rate,6.04,100% of CMS OPPS RATE ,21.41,354.54% OF CMS OPPS RATE,25.89,428.7% of CMS OPPS Rate,27.22,450.81% of CMS OPPS Rate,5.44,100% of WV Medicaid Fee Schedule,6.04,100% of CMS OPPS Rate,6.04,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,5.44,82.32,54.88
Outpatient Medical Services,LAB,83690,Lipase,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,6.89,100% of CMS OPPS Rate,6.2,100% of Medicaid Fee Schedule,6.89,100% of CMS OPPS Rate,6.89,100% of CMS OPPS RATE ,24.42,354.54% OF CMS OPPS RATE,29.53,428.7% of CMS OPPS Rate,31.06,450.81% of CMS OPPS Rate,6.2,100% of WV Medicaid Fee Schedule,6.89,100% of CMS OPPS Rate,6.89,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,6.2,82.32,54.88
Outpatient Medical Services,LAB,83735,Magnesium Level,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,6.7,100% of CMS OPPS Rate,6.03,100% of Medicaid Fee Schedule,6.7,100% of CMS OPPS Rate,6.7,100% of CMS OPPS RATE ,23.75,354.54% OF CMS OPPS RATE,28.72,428.7% of CMS OPPS Rate,30.2,450.81% of CMS OPPS Rate,6.03,100% of WV Medicaid Fee Schedule,6.7,100% of CMS OPPS Rate,6.7,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,6.03,82.32,54.88
Outpatient Medical Services,LAB,83880,Blood test used to diagnose heart failure,300,152.32,114.24,75% of Total billed charges,114.24,75% of Total billed charges,39.26,100% of CMS OPPS Rate,35.33,100% of Medicaid Fee Schedule,39.26,100% of CMS OPPS Rate,39.26,100% of CMS OPPS RATE ,139.19,354.54% OF CMS OPPS RATE,168.3,428.7% of CMS OPPS Rate,176.98,450.81% of CMS OPPS Rate,35.33,100% of WV Medicaid Fee Schedule,39.26,100% of CMS OPPS Rate,39.26,100% of CMS OPPS Rate,21.32,14% of Total Billed Charges,21.32,176.98,76.16
Outpatient Medical Services,LAB,83930,"Osmolality-Serum, STAT to Ruby",300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,6.61,100% of CMS OPPS Rate,5.95,100% of Medicaid Fee Schedule,6.61,100% of CMS OPPS Rate,6.61,100% of CMS OPPS RATE ,23.43,354.54% OF CMS OPPS RATE,28.33,428.7% of CMS OPPS Rate,29.79,450.81% of CMS OPPS Rate,5.95,100% of WV Medicaid Fee Schedule,6.61,100% of CMS OPPS Rate,6.61,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,5.95,60.48,40.32
Outpatient Medical Services,LAB,83935,"Osmolality Random Urine, SO",300,87.36,65.52,75% of Total billed charges,65.52,75% of Total billed charges,6.82,100% of CMS OPPS Rate,6.14,100% of Medicaid Fee Schedule,6.82,100% of CMS OPPS Rate,6.82,100% of CMS OPPS RATE ,24.17,354.54% OF CMS OPPS RATE,29.23,428.7% of CMS OPPS Rate,30.74,450.81% of CMS OPPS Rate,6.14,100% of WV Medicaid Fee Schedule,6.82,100% of CMS OPPS Rate,6.82,100% of CMS OPPS Rate,12.23,14% of Total Billed Charges,6.14,65.52,43.68
Outpatient Medical Services,LAB,83935,"Osmolality-Urine, STAT to Ruby",300,87.36,65.52,75% of Total billed charges,65.52,75% of Total billed charges,6.82,100% of CMS OPPS Rate,6.14,100% of Medicaid Fee Schedule,6.82,100% of CMS OPPS Rate,6.82,100% of CMS OPPS RATE ,24.17,354.54% OF CMS OPPS RATE,29.23,428.7% of CMS OPPS Rate,30.74,450.81% of CMS OPPS Rate,6.14,100% of WV Medicaid Fee Schedule,6.82,100% of CMS OPPS Rate,6.82,100% of CMS OPPS Rate,12.23,14% of Total Billed Charges,6.14,65.52,43.68
Outpatient Medical Services,LAB,84100,Phosphorus Level,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,4.74,100% of CMS OPPS Rate,4.27,100% of Medicaid Fee Schedule,4.74,100% of CMS OPPS Rate,4.74,100% of CMS OPPS RATE ,16.8,354.54% OF CMS OPPS RATE,20.32,428.7% of CMS OPPS Rate,21.36,450.81% of CMS OPPS Rate,4.27,100% of WV Medicaid Fee Schedule,4.74,100% of CMS OPPS Rate,4.74,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.27,82.32,54.88
Outpatient Medical Services,LAB,84132,"Potassium, POC",300,60.48,45.36,75% of Total billed charges,45.36,75% of Total billed charges,4.76,100% of CMS OPPS Rate,4.28,100% of Medicaid Fee Schedule,4.76,100% of CMS OPPS Rate,4.76,100% of CMS OPPS RATE ,16.87,354.54% OF CMS OPPS RATE,20.4,428.7% of CMS OPPS Rate,21.45,450.81% of CMS OPPS Rate,4.28,100% of WV Medicaid Fee Schedule,4.76,100% of CMS OPPS Rate,4.76,100% of CMS OPPS Rate,8.47,14% of Total Billed Charges,4.28,45.36,30.24
Outpatient Medical Services,LAB,84153,PSA (prostate specific antigen),300,142.24,106.68,75% of Total billed charges,106.68,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,19.91,14% of Total Billed Charges,16.55,106.68,71.12
Outpatient Medical Services,LAB,84153,PSA (prostate specific antigen),300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,15.37,82.9,54.88
Outpatient Medical Services,LAB,84153,PSA (prostate specific antigen),300,82.88,62.16,75% of Total billed charges,62.16,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,11.6,14% of Total Billed Charges,11.6,82.9,41.44
Outpatient Medical Services,LAB,84153,PSA (prostate specific antigen),300,73.56,55.17,75% of Total billed charges,55.17,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,10.3,14% of Total Billed Charges,10.3,82.9,36.78
Outpatient Medical Services,LAB,84154,PSA (prostate specific antigen) measurement,300,82.88,62.16,75% of Total billed charges,62.16,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,11.6,14% of Total Billed Charges,11.6,82.9,41.44
Outpatient Medical Services,LAB,84154,PSA (prostate specific antigen) measurement,300,89.6,67.2,75% of Total billed charges,67.2,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,12.54,14% of Total Billed Charges,12.54,82.9,44.80
Outpatient Medical Services,LAB,84154,PSA (prostate specific antigen) measurement,300,73.56,55.17,75% of Total billed charges,55.17,75% of Total billed charges,18.39,100% of CMS OPPS Rate,16.55,100% of Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS RATE ,65.19,354.54% OF CMS OPPS RATE,78.83,428.7% of CMS OPPS Rate,82.9,450.81% of CMS OPPS Rate,16.55,100% of WV Medicaid Fee Schedule,18.39,100% of CMS OPPS Rate,18.39,100% of CMS OPPS Rate,10.3,14% of Total Billed Charges,10.3,82.9,36.78
Outpatient Medical Services,LAB,84156,Protein Random Urine,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,3.67,100% of CMS OPPS Rate,3.3,100% of Medicaid Fee Schedule,3.67,100% of CMS OPPS Rate,3.67,100% of CMS OPPS RATE ,13.01,354.54% OF CMS OPPS RATE,15.73,428.7% of CMS OPPS Rate,16.54,450.81% of CMS OPPS Rate,3.3,100% of WV Medicaid Fee Schedule,3.67,100% of CMS OPPS Rate,3.67,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,3.3,82.32,54.88
Outpatient Medical Services,LAB,84157,Protein Body Fluid,300,98.56,73.92,75% of Total billed charges,73.92,75% of Total billed charges,4,100% of CMS OPPS Rate,3.6,100% of Medicaid Fee Schedule,4,100% of CMS OPPS Rate,4,100% of CMS OPPS RATE ,14.18,354.54% OF CMS OPPS RATE,17.14,428.7% of CMS OPPS Rate,18.03,450.81% of CMS OPPS Rate,3.6,100% of WV Medicaid Fee Schedule,4,100% of CMS OPPS Rate,4,100% of CMS OPPS Rate,13.8,14% of Total Billed Charges,3.6,73.92,49.28
Outpatient Medical Services,LAB,84157,Protein CSF,300,103.04,77.28,75% of Total billed charges,77.28,75% of Total billed charges,4,100% of CMS OPPS Rate,3.6,100% of Medicaid Fee Schedule,4,100% of CMS OPPS Rate,4,100% of CMS OPPS RATE ,14.18,354.54% OF CMS OPPS RATE,17.14,428.7% of CMS OPPS Rate,18.03,450.81% of CMS OPPS Rate,3.6,100% of WV Medicaid Fee Schedule,4,100% of CMS OPPS Rate,4,100% of CMS OPPS Rate,14.43,14% of Total Billed Charges,3.6,77.28,51.52
Outpatient Medical Services,LAB,84165,IFE/PE S-Fraction/Quant,300,58.24,43.68,75% of Total billed charges,43.68,75% of Total billed charges,10.74,100% of CMS OPPS Rate,9.67,100% of Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS RATE ,38.07,354.54% OF CMS OPPS RATE,46.04,428.7% of CMS OPPS Rate,48.41,450.81% of CMS OPPS Rate,9.67,100% of WV Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS Rate,8.15,14% of Total Billed Charges,8.15,48.41,29.12
Outpatient Medical Services,LAB,84244,"Renin Plasma, SO",300,151.2,113.4,75% of Total billed charges,113.4,75% of Total billed charges,21.99,100% of CMS OPPS Rate,19.79,100% of Medicaid Fee Schedule,21.99,100% of CMS OPPS Rate,21.99,100% of CMS OPPS RATE ,77.96,354.54% OF CMS OPPS RATE,94.27,428.7% of CMS OPPS Rate,99.13,450.81% of CMS OPPS Rate,19.79,100% of WV Medicaid Fee Schedule,21.99,100% of CMS OPPS Rate,21.99,100% of CMS OPPS Rate,21.17,14% of Total Billed Charges,19.79,113.4,75.60
Outpatient Medical Services,LAB,84295,"Sodium, POC",300,60.48,45.36,75% of Total billed charges,45.36,75% of Total billed charges,4.8,100% of CMS OPPS Rate,4.33,100% of Medicaid Fee Schedule,4.8,100% of CMS OPPS Rate,4.81,100% of CMS OPPS RATE ,17.05,354.54% OF CMS OPPS RATE,20.62,428.7% of CMS OPPS Rate,21.68,450.81% of CMS OPPS Rate,4.33,100% of WV Medicaid Fee Schedule,4.8,100% of CMS OPPS Rate,4.81,100% of CMS OPPS Rate,8.47,14% of Total Billed Charges,4.33,45.36,30.24
Outpatient Medical Services,LAB,84300,Sodium Level Random Urine,300,60.48,45.36,75% of Total billed charges,45.36,75% of Total billed charges,5.05,100% of CMS OPPS Rate,4.55,100% of Medicaid Fee Schedule,5.05,100% of CMS OPPS Rate,5.06,100% of CMS OPPS RATE ,17.93,354.54% OF CMS OPPS RATE,21.69,428.7% of CMS OPPS Rate,22.81,450.81% of CMS OPPS Rate,4.55,100% of WV Medicaid Fee Schedule,5.05,100% of CMS OPPS Rate,5.06,100% of CMS OPPS Rate,8.47,14% of Total Billed Charges,4.55,45.36,30.24
Outpatient Medical Services,LAB,84425,"Vitamin B1, Whole Blood, SO",300,127.68,95.76,75% of Total billed charges,95.76,75% of Total billed charges,21.23,100% of CMS OPPS Rate,19.11,100% of Medicaid Fee Schedule,21.23,100% of CMS OPPS Rate,21.23,100% of CMS OPPS RATE ,75.26,354.54% OF CMS OPPS RATE,91.01,428.7% of CMS OPPS Rate,95.7,450.81% of CMS OPPS Rate,19.11,100% of WV Medicaid Fee Schedule,21.23,100% of CMS OPPS Rate,21.23,100% of CMS OPPS Rate,17.88,14% of Total Billed Charges,17.88,95.76,63.84
Outpatient Medical Services,LAB,84436,Blood test to measure a type of thyroid hormone,300,96.32,72.24,75% of Total billed charges,72.24,75% of Total billed charges,6.87,100% of CMS OPPS Rate,6.18,100% of Medicaid Fee Schedule,6.87,100% of CMS OPPS Rate,6.87,100% of CMS OPPS RATE ,24.35,354.54% OF CMS OPPS RATE,29.45,428.7% of CMS OPPS Rate,30.97,450.81% of CMS OPPS Rate,6.18,100% of WV Medicaid Fee Schedule,6.87,100% of CMS OPPS Rate,6.87,100% of CMS OPPS Rate,13.48,14% of Total Billed Charges,6.18,72.24,48.16
Outpatient Medical Services,LAB,84439,Blood test to evaluate thyroid function,300,50.4,37.8,75% of Total billed charges,37.8,75% of Total billed charges,9.02,100% of CMS OPPS Rate,8.12,100% of Medicaid Fee Schedule,9.02,100% of CMS OPPS Rate,9.02,100% of CMS OPPS RATE ,31.97,354.54% OF CMS OPPS RATE,38.66,428.7% of CMS OPPS Rate,40.66,450.81% of CMS OPPS Rate,8.12,100% of WV Medicaid Fee Schedule,9.02,100% of CMS OPPS Rate,9.02,100% of CMS OPPS Rate,7.06,14% of Total Billed Charges,7.06,40.66,25.20
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,28,21,75% of Total billed charges,21,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,3.92,75.73,14.00
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,28,21,75% of Total billed charges,21,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,3.92,75.73,14.00
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,69.44,52.08,75% of Total billed charges,52.08,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,9.72,14% of Total Billed Charges,9.72,75.73,34.72
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,163.52,122.64,75% of Total billed charges,122.64,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,22.89,14% of Total Billed Charges,15.12,122.64,81.76
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,163.52,122.64,75% of Total billed charges,122.64,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,22.89,14% of Total Billed Charges,15.12,122.64,81.76
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",300,128.8,96.6,75% of Total billed charges,96.6,75% of Total billed charges,16.8,100% of CMS OPPS Rate,15.12,100% of Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS RATE ,59.56,354.54% OF CMS OPPS RATE,72.02,428.7% of CMS OPPS Rate,75.73,450.81% of CMS OPPS Rate,15.12,100% of WV Medicaid Fee Schedule,16.8,100% of CMS OPPS Rate,16.8,100% of CMS OPPS Rate,18.03,14% of Total Billed Charges,15.12,96.6,64.40
Outpatient Medical Services,LAB,84481,Free Triiodothyronine,300,96.32,72.24,75% of Total billed charges,72.24,75% of Total billed charges,16.94,100% of CMS OPPS Rate,15.25,100% of Medicaid Fee Schedule,16.94,100% of CMS OPPS Rate,16.94,100% of CMS OPPS RATE ,60.05,354.54% OF CMS OPPS RATE,72.62,428.7% of CMS OPPS Rate,76.36,450.81% of CMS OPPS Rate,15.25,100% of WV Medicaid Fee Schedule,16.94,100% of CMS OPPS Rate,16.94,100% of CMS OPPS Rate,13.48,14% of Total Billed Charges,13.48,76.36,48.16
Outpatient Medical Services,LAB,84484,Blood test to measure a certain protein in the blood to determine heart muscle damage,300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,12.47,100% of CMS OPPS Rate,11.22,100% of Medicaid Fee Schedule,12.47,100% of CMS OPPS Rate,12.47,100% of CMS OPPS RATE ,44.21,354.54% OF CMS OPPS RATE,53.45,428.7% of CMS OPPS Rate,56.21,450.81% of CMS OPPS Rate,11.22,100% of WV Medicaid Fee Schedule,12.47,100% of CMS OPPS Rate,12.47,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,11.22,78.96,52.64
Outpatient Medical Services,LAB,84484,Blood test to measure a certain protein in the blood to determine heart muscle damage,300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,12.47,100% of CMS OPPS Rate,11.22,100% of Medicaid Fee Schedule,12.47,100% of CMS OPPS Rate,12.47,100% of CMS OPPS RATE ,44.21,354.54% OF CMS OPPS RATE,53.45,428.7% of CMS OPPS Rate,56.21,450.81% of CMS OPPS Rate,11.22,100% of WV Medicaid Fee Schedule,12.47,100% of CMS OPPS Rate,12.47,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,11.22,78.96,52.64
Outpatient Medical Services,LAB,84520,BUN,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,3.95,100% of CMS OPPS Rate,3.56,100% of Medicaid Fee Schedule,3.95,100% of CMS OPPS Rate,3.95,100% of CMS OPPS RATE ,14,354.54% OF CMS OPPS RATE,16.93,428.7% of CMS OPPS Rate,17.8,450.81% of CMS OPPS Rate,3.56,100% of WV Medicaid Fee Schedule,3.95,100% of CMS OPPS Rate,3.95,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,3.56,56.28,37.52
Outpatient Medical Services,LAB,84550,Uric Acid,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,4.51,100% of CMS OPPS Rate,4.07,100% of Medicaid Fee Schedule,4.51,100% of CMS OPPS Rate,4.52,100% of CMS OPPS RATE ,16.02,354.54% OF CMS OPPS RATE,19.37,428.7% of CMS OPPS Rate,20.37,450.81% of CMS OPPS Rate,4.07,100% of WV Medicaid Fee Schedule,4.51,100% of CMS OPPS Rate,4.52,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,4.07,82.32,54.88
Outpatient Medical Services,LAB,84681,"C Peptide Serum, SO",300,120.96,90.72,75% of Total billed charges,90.72,75% of Total billed charges,20.81,100% of CMS OPPS Rate,18.73,100% of Medicaid Fee Schedule,20.81,100% of CMS OPPS Rate,20.81,100% of CMS OPPS RATE ,73.77,354.54% OF CMS OPPS RATE,89.21,428.7% of CMS OPPS Rate,93.81,450.81% of CMS OPPS Rate,18.73,100% of WV Medicaid Fee Schedule,20.81,100% of CMS OPPS Rate,20.81,100% of CMS OPPS Rate,16.93,14% of Total Billed Charges,16.93,93.81,60.48
Outpatient Medical Services,LAB,84702,HCG Quantitative,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,15.05,100% of CMS OPPS Rate,13.55,100% of Medicaid Fee Schedule,15.05,100% of CMS OPPS Rate,15.05,100% of CMS OPPS RATE ,53.35,354.54% OF CMS OPPS RATE,64.51,428.7% of CMS OPPS Rate,67.84,450.81% of CMS OPPS Rate,13.55,100% of WV Medicaid Fee Schedule,15.05,100% of CMS OPPS Rate,15.05,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,13.55,82.32,54.88
Outpatient Medical Services,LAB,84702,HCG Quantitative,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,15.05,100% of CMS OPPS Rate,13.55,100% of Medicaid Fee Schedule,15.05,100% of CMS OPPS Rate,15.05,100% of CMS OPPS RATE ,53.35,354.54% OF CMS OPPS RATE,64.51,428.7% of CMS OPPS Rate,67.84,450.81% of CMS OPPS Rate,13.55,100% of WV Medicaid Fee Schedule,15.05,100% of CMS OPPS Rate,15.05,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,13.55,82.32,54.88
Outpatient Medical Services,LAB,84703,Blood test to assess for pregnancy,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,7.52,100% of CMS OPPS Rate,6.77,100% of Medicaid Fee Schedule,7.52,100% of CMS OPPS Rate,7.52,100% of CMS OPPS RATE ,26.66,354.54% OF CMS OPPS RATE,32.23,428.7% of CMS OPPS Rate,33.9,450.81% of CMS OPPS Rate,6.77,100% of WV Medicaid Fee Schedule,7.52,100% of CMS OPPS Rate,7.52,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,6.77,56.28,37.52
Outpatient Medical Services,LAB,84703,Blood test to assess for pregnancy,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,7.52,100% of CMS OPPS Rate,6.77,100% of Medicaid Fee Schedule,7.52,100% of CMS OPPS Rate,7.52,100% of CMS OPPS RATE ,26.66,354.54% OF CMS OPPS RATE,32.23,428.7% of CMS OPPS Rate,33.9,450.81% of CMS OPPS Rate,6.77,100% of WV Medicaid Fee Schedule,7.52,100% of CMS OPPS Rate,7.52,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,6.77,56.28,37.52
Outpatient Medical Services,LAB,85007,Blood test to assess for infection,300,16.8,12.6,75% of Total billed charges,12.6,75% of Total billed charges,3.8,100% of CMS OPPS Rate,3.42,100% of Medicaid Fee Schedule,3.8,100% of CMS OPPS Rate,3.8,100% of CMS OPPS RATE ,13.47,354.54% OF CMS OPPS RATE,16.29,428.7% of CMS OPPS Rate,17.13,450.81% of CMS OPPS Rate,3.42,100% of WV Medicaid Fee Schedule,3.8,100% of CMS OPPS Rate,3.8,100% of CMS OPPS Rate,2.35,14% of Total Billed Charges,2.35,17.13,8.40
Outpatient Medical Services,LAB,85014,"Hematocrit, POC",300,26.88,20.16,75% of Total billed charges,20.16,75% of Total billed charges,2.37,100% of CMS OPPS Rate,2.13,100% of Medicaid Fee Schedule,2.37,100% of CMS OPPS Rate,2.37,100% of CMS OPPS RATE ,8.4,354.54% OF CMS OPPS RATE,10.16,428.7% of CMS OPPS Rate,10.68,450.81% of CMS OPPS Rate,2.13,100% of WV Medicaid Fee Schedule,2.37,100% of CMS OPPS Rate,2.37,100% of CMS OPPS Rate,3.76,14% of Total Billed Charges,2.13,20.16,13.44
Outpatient Medical Services,LAB,85018,Blood test to measure levels of hemoglobin,300,26.88,20.16,75% of Total billed charges,20.16,75% of Total billed charges,2.37,100% of CMS OPPS Rate,2.13,100% of Medicaid Fee Schedule,2.37,100% of CMS OPPS Rate,2.37,100% of CMS OPPS RATE ,8.4,354.54% OF CMS OPPS RATE,10.16,428.7% of CMS OPPS Rate,10.68,450.81% of CMS OPPS Rate,2.13,100% of WV Medicaid Fee Schedule,2.37,100% of CMS OPPS Rate,2.37,100% of CMS OPPS Rate,3.76,14% of Total Billed Charges,2.13,20.16,13.44
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,7.77,100% of CMS OPPS Rate,6.99,100% of Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS RATE ,27.54,354.54% OF CMS OPPS RATE,33.3,428.7% of CMS OPPS Rate,35.02,450.81% of CMS OPPS Rate,6.99,100% of WV Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,6.99,78.96,52.64
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,7.77,100% of CMS OPPS Rate,6.99,100% of Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS RATE ,27.54,354.54% OF CMS OPPS RATE,33.3,428.7% of CMS OPPS Rate,35.02,450.81% of CMS OPPS Rate,6.99,100% of WV Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,6.99,78.96,52.64
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,7.77,100% of CMS OPPS Rate,6.99,100% of Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS RATE ,27.54,354.54% OF CMS OPPS RATE,33.3,428.7% of CMS OPPS Rate,35.02,450.81% of CMS OPPS Rate,6.99,100% of WV Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,6.99,78.96,52.64
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,7.77,100% of CMS OPPS Rate,6.99,100% of Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS RATE ,27.54,354.54% OF CMS OPPS RATE,33.3,428.7% of CMS OPPS Rate,35.02,450.81% of CMS OPPS Rate,6.99,100% of WV Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,6.99,56.28,37.52
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,7.77,100% of CMS OPPS Rate,6.99,100% of Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS RATE ,27.54,354.54% OF CMS OPPS RATE,33.3,428.7% of CMS OPPS Rate,35.02,450.81% of CMS OPPS Rate,6.99,100% of WV Medicaid Fee Schedule,7.77,100% of CMS OPPS Rate,7.77,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,6.99,78.96,52.64
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,5.82,56.28,37.52
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,105.28,78.96,75% of Total billed charges,78.96,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,14.74,14% of Total Billed Charges,5.82,78.96,52.64
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,5.82,56.28,37.52
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,22.4,16.8,75% of Total billed charges,16.8,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,3.14,14% of Total Billed Charges,3.14,29.16,11.20
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,22.4,16.8,75% of Total billed charges,16.8,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,3.14,14% of Total Billed Charges,3.14,29.16,11.20
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,5.82,56.28,37.52
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,5.82,56.28,37.52
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,6.47,100% of CMS OPPS Rate,5.82,100% of Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS RATE ,22.93,354.54% OF CMS OPPS RATE,27.73,428.7% of CMS OPPS Rate,29.16,450.81% of CMS OPPS Rate,5.82,100% of WV Medicaid Fee Schedule,6.47,100% of CMS OPPS Rate,6.47,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,5.82,56.28,37.52
Outpatient Medical Services,LAB,85045,Reticulocyte Count Automated,300,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,3.99,100% of CMS OPPS Rate,3.59,100% of Medicaid Fee Schedule,3.99,100% of CMS OPPS Rate,3.99,100% of CMS OPPS RATE ,14.14,354.54% OF CMS OPPS RATE,17.1,428.7% of CMS OPPS Rate,17.98,450.81% of CMS OPPS Rate,3.59,100% of WV Medicaid Fee Schedule,3.99,100% of CMS OPPS Rate,3.99,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,3.59,58.8,39.20
Outpatient Medical Services,LAB,85049,Platelet Count,300,34.72,26.04,75% of Total billed charges,26.04,75% of Total billed charges,4.48,100% of CMS OPPS Rate,4.03,100% of Medicaid Fee Schedule,4.48,100% of CMS OPPS Rate,4.48,100% of CMS OPPS RATE ,15.88,354.54% OF CMS OPPS RATE,19.2,428.7% of CMS OPPS Rate,20.19,450.81% of CMS OPPS Rate,4.03,100% of WV Medicaid Fee Schedule,4.48,100% of CMS OPPS Rate,4.48,100% of CMS OPPS Rate,4.86,14% of Total Billed Charges,4.03,26.04,17.36
Outpatient Medical Services,LAB,85379,D Dimer,305,127.68,95.76,75% of Total billed charges,95.76,75% of Total billed charges,10.18,100% of CMS OPPS Rate,9.16,100% of Medicaid Fee Schedule,10.18,100% of CMS OPPS Rate,10.18,100% of CMS OPPS RATE ,36.09,354.54% OF CMS OPPS RATE,43.64,428.7% of CMS OPPS Rate,45.89,450.81% of CMS OPPS Rate,9.16,100% of WV Medicaid Fee Schedule,10.18,100% of CMS OPPS Rate,10.18,100% of CMS OPPS Rate,17.88,14% of Total Billed Charges,9.16,95.76,63.84
Outpatient Medical Services,LAB,85379,DDimer,305,127.68,95.76,75% of Total billed charges,95.76,75% of Total billed charges,10.18,100% of CMS OPPS Rate,9.16,100% of Medicaid Fee Schedule,10.18,100% of CMS OPPS Rate,10.18,100% of CMS OPPS RATE ,36.09,354.54% OF CMS OPPS RATE,43.64,428.7% of CMS OPPS Rate,45.89,450.81% of CMS OPPS Rate,9.16,100% of WV Medicaid Fee Schedule,10.18,100% of CMS OPPS Rate,10.18,100% of CMS OPPS Rate,17.88,14% of Total Billed Charges,9.16,95.76,63.84
Outpatient Medical Services,LAB,85384,Fibrinogen Level,300,118.72,89.04,75% of Total billed charges,89.04,75% of Total billed charges,9.72,100% of CMS OPPS Rate,8.75,100% of Medicaid Fee Schedule,9.72,100% of CMS OPPS Rate,9.72,100% of CMS OPPS RATE ,34.46,354.54% OF CMS OPPS RATE,41.66,428.7% of CMS OPPS Rate,43.81,450.81% of CMS OPPS Rate,8.75,100% of WV Medicaid Fee Schedule,9.72,100% of CMS OPPS Rate,9.72,100% of CMS OPPS Rate,16.62,14% of Total Billed Charges,8.75,89.04,59.36
Outpatient Medical Services,LAB,85610,"Blood test, clotting time",300,22.4,16.8,75% of Total billed charges,16.8,75% of Total billed charges,4.29,100% of CMS OPPS Rate,3.86,100% of Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS RATE ,15.2,354.54% OF CMS OPPS RATE,18.39,428.7% of CMS OPPS Rate,19.33,450.81% of CMS OPPS Rate,3.86,100% of WV Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS Rate,3.14,14% of Total Billed Charges,3.14,19.33,11.20
Outpatient Medical Services,LAB,85610,"Blood test, clotting time",300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,4.29,100% of CMS OPPS Rate,3.86,100% of Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS RATE ,15.2,354.54% OF CMS OPPS RATE,18.39,428.7% of CMS OPPS Rate,19.33,450.81% of CMS OPPS Rate,3.86,100% of WV Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,3.86,60.48,40.32
Outpatient Medical Services,LAB,85610,"Blood test, clotting time",300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,4.29,100% of CMS OPPS Rate,3.86,100% of Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS RATE ,15.2,354.54% OF CMS OPPS RATE,18.39,428.7% of CMS OPPS Rate,19.33,450.81% of CMS OPPS Rate,3.86,100% of WV Medicaid Fee Schedule,4.29,100% of CMS OPPS Rate,4.29,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,3.86,60.48,40.32
Outpatient Medical Services,LAB,85652,ESR,300,86.24,64.68,75% of Total billed charges,64.68,75% of Total billed charges,2.7,100% of CMS OPPS Rate,2.43,100% of Medicaid Fee Schedule,2.7,100% of CMS OPPS Rate,2.7,100% of CMS OPPS RATE ,9.57,354.54% OF CMS OPPS RATE,11.57,428.7% of CMS OPPS Rate,12.17,450.81% of CMS OPPS Rate,2.43,100% of WV Medicaid Fee Schedule,2.7,100% of CMS OPPS Rate,2.7,100% of CMS OPPS Rate,12.07,14% of Total Billed Charges,2.43,64.68,43.12
Outpatient Medical Services,LAB,85730,Coagulation assessment blood test,300,86.24,64.68,75% of Total billed charges,64.68,75% of Total billed charges,6.01,100% of CMS OPPS Rate,5.41,100% of Medicaid Fee Schedule,6.01,100% of CMS OPPS Rate,6.01,100% of CMS OPPS RATE ,21.3,354.54% OF CMS OPPS RATE,25.76,428.7% of CMS OPPS Rate,27.09,450.81% of CMS OPPS Rate,5.41,100% of WV Medicaid Fee Schedule,6.01,100% of CMS OPPS Rate,6.01,100% of CMS OPPS Rate,12.07,14% of Total Billed Charges,5.41,64.68,43.12
Outpatient Medical Services,LAB,85730,Coagulation assessment blood test,300,86.24,64.68,75% of Total billed charges,64.68,75% of Total billed charges,6.01,100% of CMS OPPS Rate,5.41,100% of Medicaid Fee Schedule,6.01,100% of CMS OPPS Rate,6.01,100% of CMS OPPS RATE ,21.3,354.54% OF CMS OPPS RATE,25.76,428.7% of CMS OPPS Rate,27.09,450.81% of CMS OPPS Rate,5.41,100% of WV Medicaid Fee Schedule,6.01,100% of CMS OPPS Rate,6.01,100% of CMS OPPS Rate,12.07,14% of Total Billed Charges,5.41,64.68,43.12
Outpatient Medical Services,LAB,86140,C Reactive Protein,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,5.18,100% of CMS OPPS Rate,4.66,100% of Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS RATE ,18.36,354.54% OF CMS OPPS RATE,22.2,428.7% of CMS OPPS Rate,23.35,450.81% of CMS OPPS Rate,4.66,100% of WV Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,4.66,56.28,37.52
Outpatient Medical Services,LAB,86308,MC Monospot,300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,5.18,100% of CMS OPPS Rate,4.66,100% of Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS RATE ,18.36,354.54% OF CMS OPPS RATE,22.2,428.7% of CMS OPPS Rate,23.35,450.81% of CMS OPPS Rate,4.66,100% of WV Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,4.66,60.48,40.32
Outpatient Medical Services,LAB,86308,Monospot,300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,5.18,100% of CMS OPPS Rate,4.66,100% of Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS RATE ,18.36,354.54% OF CMS OPPS RATE,22.2,428.7% of CMS OPPS Rate,23.35,450.81% of CMS OPPS Rate,4.66,100% of WV Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,4.66,60.48,40.32
Outpatient Medical Services,LAB,86334,IFE/PE S-Immunofix Electr,300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,22.34,100% of CMS OPPS Rate,20.11,100% of Medicaid Fee Schedule,22.34,100% of CMS OPPS Rate,22.34,100% of CMS OPPS RATE ,79.2,354.54% OF CMS OPPS RATE,95.77,428.7% of CMS OPPS Rate,100.71,450.81% of CMS OPPS Rate,20.11,100% of WV Medicaid Fee Schedule,22.34,100% of CMS OPPS Rate,22.34,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,15.37,100.71,54.88
Outpatient Medical Services,LAB,86617,"Lyme, Western Blot 86617 Add-On",300,61.96,46.47,75% of Total billed charges,46.47,75% of Total billed charges,15.49,100% of CMS OPPS Rate,13.94,100% of Medicaid Fee Schedule,15.49,100% of CMS OPPS Rate,15.49,100% of CMS OPPS RATE ,54.91,354.54% OF CMS OPPS RATE,66.4,428.7% of CMS OPPS Rate,69.83,450.81% of CMS OPPS Rate,13.94,100% of WV Medicaid Fee Schedule,15.49,100% of CMS OPPS Rate,15.49,100% of CMS OPPS Rate,8.67,14% of Total Billed Charges,8.67,69.83,30.98
Outpatient Medical Services,LAB,86617,"Lyme, Western Blot, Serum LC",300,61.96,46.47,75% of Total billed charges,46.47,75% of Total billed charges,15.49,100% of CMS OPPS Rate,13.94,100% of Medicaid Fee Schedule,15.49,100% of CMS OPPS Rate,15.49,100% of CMS OPPS RATE ,54.91,354.54% OF CMS OPPS RATE,66.4,428.7% of CMS OPPS Rate,69.83,450.81% of CMS OPPS Rate,13.94,100% of WV Medicaid Fee Schedule,15.49,100% of CMS OPPS Rate,15.49,100% of CMS OPPS Rate,8.67,14% of Total Billed Charges,8.67,69.83,30.98
Outpatient Medical Services,LAB,86618,"Lyme Disease, Total Antibodies w Reflex, SO",300,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,17.03,100% of CMS OPPS Rate,15.33,100% of Medicaid Fee Schedule,17.03,100% of CMS OPPS Rate,17.03,100% of CMS OPPS RATE ,60.37,354.54% OF CMS OPPS RATE,73,428.7% of CMS OPPS Rate,76.77,450.81% of CMS OPPS Rate,15.33,100% of WV Medicaid Fee Schedule,17.03,100% of CMS OPPS Rate,17.03,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,10.98,76.77,39.20
Outpatient Medical Services,LAB,86703,Blood test to diagnose HIV,300,127.68,95.76,75% of Total billed charges,95.76,75% of Total billed charges,13.71,100% of CMS OPPS Rate,12.34,100% of Medicaid Fee Schedule,13.71,100% of CMS OPPS Rate,13.71,100% of CMS OPPS RATE ,48.6,354.54% OF CMS OPPS RATE,58.77,428.7% of CMS OPPS Rate,61.8,450.81% of CMS OPPS Rate,12.34,100% of WV Medicaid Fee Schedule,13.71,100% of CMS OPPS Rate,13.71,100% of CMS OPPS Rate,17.88,14% of Total Billed Charges,12.34,95.76,63.84
Outpatient Medical Services,LAB,86704,Blood test indicating infection with Hepatitis B,300,57.12,42.84,75% of Total billed charges,42.84,75% of Total billed charges,12.05,100% of CMS OPPS Rate,10.85,100% of Medicaid Fee Schedule,12.05,100% of CMS OPPS Rate,12.05,100% of CMS OPPS RATE ,42.72,354.54% OF CMS OPPS RATE,51.65,428.7% of CMS OPPS Rate,54.32,450.81% of CMS OPPS Rate,10.85,100% of WV Medicaid Fee Schedule,12.05,100% of CMS OPPS Rate,12.05,100% of CMS OPPS Rate,8,14% of Total Billed Charges,8,54.32,28.56
Outpatient Medical Services,LAB,86704,Blood test indicating infection with Hepatitis B,300,91.84,68.88,75% of Total billed charges,68.88,75% of Total billed charges,12.05,100% of CMS OPPS Rate,10.85,100% of Medicaid Fee Schedule,12.05,100% of CMS OPPS Rate,12.05,100% of CMS OPPS RATE ,42.72,354.54% OF CMS OPPS RATE,51.65,428.7% of CMS OPPS Rate,54.32,450.81% of CMS OPPS Rate,10.85,100% of WV Medicaid Fee Schedule,12.05,100% of CMS OPPS Rate,12.05,100% of CMS OPPS Rate,12.86,14% of Total Billed Charges,10.85,68.88,45.92
Outpatient Medical Services,LAB,86705,"Hep VIII, HBcAb, IgM",300,89.6,67.2,75% of Total billed charges,67.2,75% of Total billed charges,11.77,100% of CMS OPPS Rate,10.59,100% of Medicaid Fee Schedule,11.77,100% of CMS OPPS Rate,11.77,100% of CMS OPPS RATE ,41.72,354.54% OF CMS OPPS RATE,50.45,428.7% of CMS OPPS Rate,53.06,450.81% of CMS OPPS Rate,10.59,100% of WV Medicaid Fee Schedule,11.77,100% of CMS OPPS Rate,11.77,100% of CMS OPPS Rate,12.54,14% of Total Billed Charges,10.59,67.2,44.80
Outpatient Medical Services,LAB,86705,"Hepatitis B Core Antibody IgM, SO",300,69.44,52.08,75% of Total billed charges,52.08,75% of Total billed charges,11.77,100% of CMS OPPS Rate,10.59,100% of Medicaid Fee Schedule,11.77,100% of CMS OPPS Rate,11.77,100% of CMS OPPS RATE ,41.72,354.54% OF CMS OPPS RATE,50.45,428.7% of CMS OPPS Rate,53.06,450.81% of CMS OPPS Rate,10.59,100% of WV Medicaid Fee Schedule,11.77,100% of CMS OPPS Rate,11.77,100% of CMS OPPS Rate,9.72,14% of Total Billed Charges,9.72,53.06,34.72
Outpatient Medical Services,LAB,86706,"EH Hepatitis Panel, HBsAB",300,49.28,36.96,75% of Total billed charges,36.96,75% of Total billed charges,10.74,100% of CMS OPPS Rate,9.67,100% of Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS RATE ,38.07,354.54% OF CMS OPPS RATE,46.04,428.7% of CMS OPPS Rate,48.41,450.81% of CMS OPPS Rate,9.67,100% of WV Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS Rate,6.9,14% of Total Billed Charges,6.9,48.41,24.64
Outpatient Medical Services,LAB,86706,"Hep VIII, HBsAb",300,82.88,62.16,75% of Total billed charges,62.16,75% of Total billed charges,10.74,100% of CMS OPPS Rate,9.67,100% of Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS RATE ,38.07,354.54% OF CMS OPPS RATE,46.04,428.7% of CMS OPPS Rate,48.41,450.81% of CMS OPPS Rate,9.67,100% of WV Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS Rate,11.6,14% of Total Billed Charges,9.67,62.16,41.44
Outpatient Medical Services,LAB,86706,Hepatitis B Surface - Antibody,300,61.6,46.2,75% of Total billed charges,46.2,75% of Total billed charges,10.74,100% of CMS OPPS Rate,9.67,100% of Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS RATE ,38.07,354.54% OF CMS OPPS RATE,46.04,428.7% of CMS OPPS Rate,48.41,450.81% of CMS OPPS Rate,9.67,100% of WV Medicaid Fee Schedule,10.74,100% of CMS OPPS Rate,10.74,100% of CMS OPPS Rate,8.62,14% of Total Billed Charges,8.62,48.41,30.80
Outpatient Medical Services,LAB,86707,"Hep VIII, HBeAb",300,87.36,65.52,75% of Total billed charges,65.52,75% of Total billed charges,11.57,100% of CMS OPPS Rate,10.41,100% of Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS RATE ,41.02,354.54% OF CMS OPPS RATE,49.6,428.7% of CMS OPPS Rate,52.15,450.81% of CMS OPPS Rate,10.41,100% of WV Medicaid Fee Schedule,11.57,100% of CMS OPPS Rate,11.57,100% of CMS OPPS Rate,12.23,14% of Total Billed Charges,10.41,65.52,43.68
Outpatient Medical Services,LAB,86709,"Hepatitis A Antibody, IgM",300,64.96,48.72,75% of Total billed charges,48.72,75% of Total billed charges,11.26,100% of CMS OPPS Rate,10.13,100% of Medicaid Fee Schedule,11.26,100% of CMS OPPS Rate,11.26,100% of CMS OPPS RATE ,39.92,354.54% OF CMS OPPS RATE,48.27,428.7% of CMS OPPS Rate,50.76,450.81% of CMS OPPS Rate,10.13,100% of WV Medicaid Fee Schedule,11.26,100% of CMS OPPS Rate,11.26,100% of CMS OPPS Rate,9.09,14% of Total Billed Charges,9.09,50.76,32.48
Outpatient Medical Services,LAB,86735,"Mumps Antibodies IgG, SO",300,85.12,63.84,75% of Total billed charges,63.84,75% of Total billed charges,13.05,100% of CMS OPPS Rate,11.75,100% of Medicaid Fee Schedule,13.05,100% of CMS OPPS Rate,13.05,100% of CMS OPPS RATE ,46.26,354.54% OF CMS OPPS RATE,55.94,428.7% of CMS OPPS Rate,58.83,450.81% of CMS OPPS Rate,11.75,100% of WV Medicaid Fee Schedule,13.05,100% of CMS OPPS Rate,13.05,100% of CMS OPPS Rate,11.92,14% of Total Billed Charges,11.75,63.84,42.56
Outpatient Medical Services,LAB,86803,Blood test to determine infection with Hepatitis C,300,59.36,44.52,75% of Total billed charges,44.52,75% of Total billed charges,14.27,100% of CMS OPPS Rate,12.84,100% of Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS RATE ,50.59,354.54% OF CMS OPPS RATE,61.17,428.7% of CMS OPPS Rate,64.33,450.81% of CMS OPPS Rate,12.84,100% of WV Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS Rate,8.31,14% of Total Billed Charges,8.31,64.33,29.68
Outpatient Medical Services,LAB,86803,Blood test to determine infection with Hepatitis C,300,103.04,77.28,75% of Total billed charges,77.28,75% of Total billed charges,14.27,100% of CMS OPPS Rate,12.84,100% of Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS RATE ,50.59,354.54% OF CMS OPPS RATE,61.17,428.7% of CMS OPPS Rate,64.33,450.81% of CMS OPPS Rate,12.84,100% of WV Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS Rate,14.43,14% of Total Billed Charges,12.84,77.28,51.52
Outpatient Medical Services,LAB,86803,Blood test to determine infection with Hepatitis C,300,77.28,57.96,75% of Total billed charges,57.96,75% of Total billed charges,14.27,100% of CMS OPPS Rate,12.84,100% of Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS RATE ,50.59,354.54% OF CMS OPPS RATE,61.17,428.7% of CMS OPPS Rate,64.33,450.81% of CMS OPPS Rate,12.84,100% of WV Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS Rate,10.82,14% of Total Billed Charges,10.82,64.33,38.64
Outpatient Medical Services,LAB,86803,Blood test to determine infection with Hepatitis C,300,80.64,60.48,75% of Total billed charges,60.48,75% of Total billed charges,14.27,100% of CMS OPPS Rate,12.84,100% of Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS RATE ,50.59,354.54% OF CMS OPPS RATE,61.17,428.7% of CMS OPPS Rate,64.33,450.81% of CMS OPPS Rate,12.84,100% of WV Medicaid Fee Schedule,14.27,100% of CMS OPPS Rate,14.27,100% of CMS OPPS Rate,11.29,14% of Total Billed Charges,11.29,64.33,40.32
Outpatient Medical Services,LAB,86850,Blood test to screen for antibodies that could harm red blood cells,300,206.5,154.88,75% of Total billed charges,154.88,75% of Total billed charges,47.13,100% of CMS OPPS Rate,8.79,100% of Medicaid Fee Schedule,77.78,165% of CMS OPPS Rate,48.85,111% CMS OPPS Rate,135.4,307.63% of CMS OPPS RATE,185.69,421.89% of CMS OPPS Rate,232.6,258.46% of CMS OPPS Rate,8.79,100% of WV Medicaid Fee Schedule,47.13,100% of CMS OPPS Rate,48.85,111% of CMS OPPS Rate ,28.91,14% of Total Billed Charges,8.79,232.6,103.25
Outpatient Medical Services,LAB,86870,Antibody Identification,300,1210.32,907.74,75% of Total billed charges,907.74,75% of Total billed charges,304.7,100% of CMS OPPS Rate,22.58,100% of Medicaid Fee Schedule,502.78,165% of CMS OPPS Rate,315.81,111% CMS OPPS Rate,875.25,307.63% of CMS OPPS RATE,1200.34,421.89% of CMS OPPS Rate,1503.55,258.46% of CMS OPPS Rate,22.58,100% of WV Medicaid Fee Schedule,304.7,100% of CMS OPPS Rate,315.81,111% of CMS OPPS Rate ,169.44,14% of Total Billed Charges,22.58,1503.55,605.16
Outpatient Medical Services,LAB,86880,DAT Interp,300,231.34,173.51,75% of Total billed charges,173.51,75% of Total billed charges,54.04,100% of CMS OPPS Rate,4.85,100% of Medicaid Fee Schedule,89.16,165% of CMS OPPS Rate,56,111% CMS OPPS Rate,155.22,307.63% of CMS OPPS RATE,212.87,421.89% of CMS OPPS Rate,266.65,258.46% of CMS OPPS Rate,4.85,100% of WV Medicaid Fee Schedule,54.04,100% of CMS OPPS Rate,56,111% of CMS OPPS Rate ,32.39,14% of Total Billed Charges,4.85,266.65,115.67
Outpatient Medical Services,LAB,86885,ABID Additional Panel,300,619.78,464.84,75% of Total billed charges,464.84,75% of Total billed charges,147.84,100% of CMS OPPS Rate,5.15,100% of Medicaid Fee Schedule,243.93,165% of CMS OPPS Rate,153.22,111% CMS OPPS Rate,424.65,307.63% of CMS OPPS RATE,582.37,421.89% of CMS OPPS Rate,729.48,258.46% of CMS OPPS Rate,5.15,100% of WV Medicaid Fee Schedule,147.84,100% of CMS OPPS Rate,153.22,111% of CMS OPPS Rate ,86.77,14% of Total Billed Charges,5.15,729.48,309.89
Outpatient Medical Services,LAB,86885,Antibody ID-each cell selected,300,619.78,464.84,75% of Total billed charges,464.84,75% of Total billed charges,147.84,100% of CMS OPPS Rate,5.15,100% of Medicaid Fee Schedule,243.93,165% of CMS OPPS Rate,153.22,111% CMS OPPS Rate,424.65,307.63% of CMS OPPS RATE,582.37,421.89% of CMS OPPS Rate,729.48,258.46% of CMS OPPS Rate,5.15,100% of WV Medicaid Fee Schedule,147.84,100% of CMS OPPS Rate,153.22,111% of CMS OPPS Rate ,86.77,14% of Total Billed Charges,5.15,729.48,309.89
Outpatient Medical Services,LAB,86900,ABO-Rh Auto,300,468.6,351.45,75% of Total billed charges,351.45,75% of Total billed charges,109.16,100% of CMS OPPS Rate,2.69,100% of Medicaid Fee Schedule,180.11,165% of CMS OPPS Rate,113.13,111% CMS OPPS Rate,313.55,307.63% of CMS OPPS RATE,430.01,421.89% of CMS OPPS Rate,538.63,258.46% of CMS OPPS Rate,2.69,100% of WV Medicaid Fee Schedule,109.16,100% of CMS OPPS Rate,113.13,111% of CMS OPPS Rate ,65.6,14% of Total Billed Charges,2.69,538.63,234.30
Outpatient Medical Services,LAB,86900,ABO-Rh Type,300,468.6,351.45,75% of Total billed charges,351.45,75% of Total billed charges,109.16,100% of CMS OPPS Rate,2.69,100% of Medicaid Fee Schedule,180.11,165% of CMS OPPS Rate,113.13,111% CMS OPPS Rate,313.55,307.63% of CMS OPPS RATE,430.01,421.89% of CMS OPPS Rate,538.63,258.46% of CMS OPPS Rate,2.69,100% of WV Medicaid Fee Schedule,109.16,100% of CMS OPPS Rate,113.13,111% of CMS OPPS Rate ,65.6,14% of Total Billed Charges,2.69,538.63,234.30
Outpatient Medical Services,LAB,86901,Rh Type,300,140.67,105.5,75% of Total billed charges,105.5,75% of Total billed charges,31.92,100% of CMS OPPS Rate,2.69,100% of Medicaid Fee Schedule,52.68,165% of CMS OPPS Rate,33.09,111% CMS OPPS Rate,91.7,307.63% of CMS OPPS RATE,125.77,421.89% of CMS OPPS Rate,157.54,258.46% of CMS OPPS Rate,2.69,100% of WV Medicaid Fee Schedule,31.92,100% of CMS OPPS Rate,33.09,111% of CMS OPPS Rate ,19.69,14% of Total Billed Charges,2.69,157.54,70.34
Outpatient Medical Services,LAB,86901,Rh Type Auto,300,140.67,105.5,75% of Total billed charges,105.5,75% of Total billed charges,31.92,100% of CMS OPPS Rate,2.69,100% of Medicaid Fee Schedule,52.68,165% of CMS OPPS Rate,33.09,111% CMS OPPS Rate,91.7,307.63% of CMS OPPS RATE,125.77,421.89% of CMS OPPS Rate,157.54,258.46% of CMS OPPS Rate,2.69,100% of WV Medicaid Fee Schedule,31.92,100% of CMS OPPS Rate,33.09,111% of CMS OPPS Rate ,19.69,14% of Total Billed Charges,2.69,157.54,70.34
Outpatient Medical Services,LAB,86901,Rh-Type,300,140.67,105.5,75% of Total billed charges,105.5,75% of Total billed charges,31.92,100% of CMS OPPS Rate,2.69,100% of Medicaid Fee Schedule,52.68,165% of CMS OPPS Rate,33.09,111% CMS OPPS Rate,91.7,307.63% of CMS OPPS RATE,125.77,421.89% of CMS OPPS Rate,157.54,258.46% of CMS OPPS Rate,2.69,100% of WV Medicaid Fee Schedule,31.92,100% of CMS OPPS Rate,33.09,111% of CMS OPPS Rate ,19.69,14% of Total Billed Charges,2.69,157.54,70.34
Outpatient Medical Services,LAB,86902,Ag Type Billing,300,1210.32,907.74,75% of Total billed charges,907.74,75% of Total billed charges,304.7,100% of CMS OPPS Rate,5.72,100% of Medicaid Fee Schedule,502.78,165% of CMS OPPS Rate,315.81,111% CMS OPPS Rate,875.25,307.63% of CMS OPPS RATE,1200.34,421.89% of CMS OPPS Rate,1503.55,258.46% of CMS OPPS Rate,5.72,100% of WV Medicaid Fee Schedule,304.7,100% of CMS OPPS Rate,315.81,111% of CMS OPPS Rate ,169.44,14% of Total Billed Charges,5.72,1503.55,605.16
Outpatient Medical Services,LAB,86902,C-,300,1210.32,907.74,75% of Total billed charges,907.74,75% of Total billed charges,304.7,100% of CMS OPPS Rate,5.72,100% of Medicaid Fee Schedule,502.78,165% of CMS OPPS Rate,315.81,111% CMS OPPS Rate,875.25,307.63% of CMS OPPS RATE,1200.34,421.89% of CMS OPPS Rate,1503.55,258.46% of CMS OPPS Rate,5.72,100% of WV Medicaid Fee Schedule,304.7,100% of CMS OPPS Rate,315.81,111% of CMS OPPS Rate ,169.44,14% of Total Billed Charges,5.72,1503.55,605.16
Outpatient Medical Services,LAB,86902,E-,300,1210.32,907.74,75% of Total billed charges,907.74,75% of Total billed charges,304.7,100% of CMS OPPS Rate,5.72,100% of Medicaid Fee Schedule,502.78,165% of CMS OPPS Rate,315.81,111% CMS OPPS Rate,875.25,307.63% of CMS OPPS RATE,1200.34,421.89% of CMS OPPS Rate,1503.55,258.46% of CMS OPPS Rate,5.72,100% of WV Medicaid Fee Schedule,304.7,100% of CMS OPPS Rate,315.81,111% of CMS OPPS Rate ,169.44,14% of Total Billed Charges,5.72,1503.55,605.16
Outpatient Medical Services,LAB,86902,JkA-,300,1210.32,907.74,75% of Total billed charges,907.74,75% of Total billed charges,304.7,100% of CMS OPPS Rate,5.72,100% of Medicaid Fee Schedule,502.78,165% of CMS OPPS Rate,315.81,111% CMS OPPS Rate,875.25,307.63% of CMS OPPS RATE,1200.34,421.89% of CMS OPPS Rate,1503.55,258.46% of CMS OPPS Rate,5.72,100% of WV Medicaid Fee Schedule,304.7,100% of CMS OPPS Rate,315.81,111% of CMS OPPS Rate ,169.44,14% of Total Billed Charges,5.72,1503.55,605.16
Outpatient Medical Services,LAB,86922,AHG Crossmatch Gel,300,619.78,464.84,75% of Total billed charges,464.84,75% of Total billed charges,147.84,100% of CMS OPPS Rate,21.45,100% of Medicaid Fee Schedule,243.93,165% of CMS OPPS Rate,153.22,111% CMS OPPS Rate,424.65,307.63% of CMS OPPS RATE,582.37,421.89% of CMS OPPS Rate,729.48,258.46% of CMS OPPS Rate,21.45,100% of WV Medicaid Fee Schedule,147.84,100% of CMS OPPS Rate,153.22,111% of CMS OPPS Rate ,86.77,14% of Total Billed Charges,21.45,729.48,309.89
Outpatient Medical Services,LAB,86922,IS Crossmatch,300,619.78,464.84,75% of Total billed charges,464.84,75% of Total billed charges,147.84,100% of CMS OPPS Rate,21.45,100% of Medicaid Fee Schedule,243.93,165% of CMS OPPS Rate,153.22,111% CMS OPPS Rate,424.65,307.63% of CMS OPPS RATE,582.37,421.89% of CMS OPPS Rate,729.48,258.46% of CMS OPPS Rate,21.45,100% of WV Medicaid Fee Schedule,147.84,100% of CMS OPPS Rate,153.22,111% of CMS OPPS Rate ,86.77,14% of Total Billed Charges,21.45,729.48,309.89
Outpatient Medical Services,LAB,87015,"Malaria, Thick Smear (Conc)",300,68.32,51.24,75% of Total billed charges,51.24,75% of Total billed charges,6.68,100% of CMS OPPS Rate,6.01,100% of Medicaid Fee Schedule,6.68,100% of CMS OPPS Rate,6.68,100% of CMS OPPS RATE ,23.68,354.54% OF CMS OPPS RATE,28.63,428.7% of CMS OPPS Rate,30.11,450.81% of CMS OPPS Rate,6.01,100% of WV Medicaid Fee Schedule,6.68,100% of CMS OPPS Rate,6.68,100% of CMS OPPS Rate,9.56,14% of Total Billed Charges,6.01,51.24,34.16
Outpatient Medical Services,LAB,87040,Blood test to screen for bacteria in the blood,300,265.44,199.08,75% of Total billed charges,199.08,75% of Total billed charges,10.32,100% of CMS OPPS Rate,9.29,100% of Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS RATE ,36.58,354.54% OF CMS OPPS RATE,44.24,428.7% of CMS OPPS Rate,46.52,450.81% of CMS OPPS Rate,9.29,100% of WV Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS Rate,37.16,14% of Total Billed Charges,9.29,199.08,132.72
Outpatient Medical Services,LAB,87040,Blood test to screen for bacteria in the blood,300,265.44,199.08,75% of Total billed charges,199.08,75% of Total billed charges,10.32,100% of CMS OPPS Rate,9.29,100% of Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS RATE ,36.58,354.54% OF CMS OPPS RATE,44.24,428.7% of CMS OPPS Rate,46.52,450.81% of CMS OPPS Rate,9.29,100% of WV Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS Rate,37.16,14% of Total Billed Charges,9.29,199.08,132.72
Outpatient Medical Services,LAB,87045,Culture Stool,300,41.44,31.08,75% of Total billed charges,31.08,75% of Total billed charges,9.44,100% of CMS OPPS Rate,8.5,100% of Medicaid Fee Schedule,9.44,100% of CMS OPPS Rate,9.44,100% of CMS OPPS RATE ,33.46,354.54% OF CMS OPPS RATE,40.46,428.7% of CMS OPPS Rate,42.55,450.81% of CMS OPPS Rate,8.5,100% of WV Medicaid Fee Schedule,9.44,100% of CMS OPPS Rate,9.44,100% of CMS OPPS Rate,5.8,14% of Total Billed Charges,5.8,42.55,20.72
Outpatient Medical Services,LAB,87046,Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract,300,29.12,21.84,75% of Total billed charges,21.84,75% of Total billed charges,9.44,100% of CMS OPPS Rate,8.5,100% of Medicaid Fee Schedule,9.44,100% of CMS OPPS Rate,9.44,100% of CMS OPPS RATE ,33.46,354.54% OF CMS OPPS RATE,40.46,428.7% of CMS OPPS Rate,42.55,450.81% of CMS OPPS Rate,8.5,100% of WV Medicaid Fee Schedule,9.44,100% of CMS OPPS Rate,9.44,100% of CMS OPPS Rate,4.08,14% of Total Billed Charges,4.08,42.55,14.56
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,147.84,110.88,75% of Total billed charges,110.88,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,20.7,14% of Total Billed Charges,7.76,110.88,73.92
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,112,84,75% of Total billed charges,84,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,15.68,14% of Total Billed Charges,7.76,84,56.00
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,213.92,160.44,75% of Total billed charges,160.44,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,29.95,14% of Total Billed Charges,7.76,160.44,106.96
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,112,84,75% of Total billed charges,84,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,15.68,14% of Total Billed Charges,7.76,84,56.00
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,147.84,110.88,75% of Total billed charges,110.88,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,20.7,14% of Total Billed Charges,7.76,110.88,73.92
Outpatient Medical Services,LAB,87070,Test of body fluid other than blood to assess for bacteria,300,147.84,110.88,75% of Total billed charges,110.88,75% of Total billed charges,8.61,100% of CMS OPPS Rate,7.76,100% of Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS RATE ,30.56,354.54% OF CMS OPPS RATE,36.95,428.7% of CMS OPPS Rate,38.85,450.81% of CMS OPPS Rate,7.76,100% of WV Medicaid Fee Schedule,8.61,100% of CMS OPPS Rate,8.62,100% of CMS OPPS Rate,20.7,14% of Total Billed Charges,7.76,110.88,73.92
Outpatient Medical Services,LAB,87075,Culture Anaerobic,300,201.6,151.2,75% of Total billed charges,151.2,75% of Total billed charges,9.47,100% of CMS OPPS Rate,8.52,100% of Medicaid Fee Schedule,9.47,100% of CMS OPPS Rate,9.47,100% of CMS OPPS RATE ,33.57,354.54% OF CMS OPPS RATE,40.59,428.7% of CMS OPPS Rate,42.69,450.81% of CMS OPPS Rate,8.52,100% of WV Medicaid Fee Schedule,9.47,100% of CMS OPPS Rate,9.47,100% of CMS OPPS Rate,28.22,14% of Total Billed Charges,8.52,151.2,100.80
Outpatient Medical Services,LAB,87076,MALDI ANA,300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,8.08,100% of CMS OPPS Rate,7.27,100% of Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS RATE ,28.64,354.54% OF CMS OPPS RATE,34.63,428.7% of CMS OPPS Rate,36.42,450.81% of CMS OPPS Rate,7.27,100% of WV Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,6.74,36.42,24.08
Outpatient Medical Services,LAB,87077,Test of a wound for type of bacterial infection,300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,8.08,100% of CMS OPPS Rate,7.27,100% of Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS RATE ,28.64,354.54% OF CMS OPPS RATE,34.63,428.7% of CMS OPPS Rate,36.42,450.81% of CMS OPPS Rate,7.27,100% of WV Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,6.74,36.42,24.08
Outpatient Medical Services,LAB,87077,Test of a wound for type of bacterial infection,300,58.24,43.68,75% of Total billed charges,43.68,75% of Total billed charges,8.08,100% of CMS OPPS Rate,7.27,100% of Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS RATE ,28.64,354.54% OF CMS OPPS RATE,34.63,428.7% of CMS OPPS Rate,36.42,450.81% of CMS OPPS Rate,7.27,100% of WV Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS Rate,8.15,14% of Total Billed Charges,7.27,43.68,29.12
Outpatient Medical Services,LAB,87077,Test of a wound for type of bacterial infection,300,58.24,43.68,75% of Total billed charges,43.68,75% of Total billed charges,8.08,100% of CMS OPPS Rate,7.27,100% of Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS RATE ,28.64,354.54% OF CMS OPPS RATE,34.63,428.7% of CMS OPPS Rate,36.42,450.81% of CMS OPPS Rate,7.27,100% of WV Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS Rate,8.15,14% of Total Billed Charges,7.27,43.68,29.12
Outpatient Medical Services,LAB,87077,Test of a wound for type of bacterial infection,300,58.24,43.68,75% of Total billed charges,43.68,75% of Total billed charges,8.08,100% of CMS OPPS Rate,7.27,100% of Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS RATE ,28.64,354.54% OF CMS OPPS RATE,34.63,428.7% of CMS OPPS Rate,36.42,450.81% of CMS OPPS Rate,7.27,100% of WV Medicaid Fee Schedule,8.08,100% of CMS OPPS Rate,8.08,100% of CMS OPPS Rate,8.15,14% of Total Billed Charges,7.27,43.68,29.12
Outpatient Medical Services,LAB,87081,Medical test to find an infection,300,82.88,62.16,75% of Total billed charges,62.16,75% of Total billed charges,6.63,100% of CMS OPPS Rate,5.97,100% of Medicaid Fee Schedule,6.63,100% of CMS OPPS Rate,6.63,100% of CMS OPPS RATE ,23.5,354.54% OF CMS OPPS RATE,28.42,428.7% of CMS OPPS Rate,29.88,450.81% of CMS OPPS Rate,5.97,100% of WV Medicaid Fee Schedule,6.63,100% of CMS OPPS Rate,6.63,100% of CMS OPPS Rate,11.6,14% of Total Billed Charges,5.97,62.16,41.44
Outpatient Medical Services,LAB,87086,Culture of the urine to determine number of bacteria,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,8.07,100% of CMS OPPS Rate,7.26,100% of Medicaid Fee Schedule,8.07,100% of CMS OPPS Rate,8.07,100% of CMS OPPS RATE ,28.61,354.54% OF CMS OPPS RATE,34.59,428.7% of CMS OPPS Rate,36.38,450.81% of CMS OPPS Rate,7.26,100% of WV Medicaid Fee Schedule,8.07,100% of CMS OPPS Rate,8.07,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.26,39.48,26.32
Outpatient Medical Services,LAB,87088,Culture of the urine to determine bacterial infection,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,8.09,100% of CMS OPPS Rate,7.28,100% of Medicaid Fee Schedule,8.09,100% of CMS OPPS Rate,8.09,100% of CMS OPPS RATE ,28.68,354.54% OF CMS OPPS RATE,34.68,428.7% of CMS OPPS Rate,36.47,450.81% of CMS OPPS Rate,7.28,100% of WV Medicaid Fee Schedule,8.09,100% of CMS OPPS Rate,8.09,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.28,39.48,26.32
Outpatient Medical Services,LAB,87106,MALDI YEAST,300,58.24,43.68,75% of Total billed charges,43.68,75% of Total billed charges,10.32,100% of CMS OPPS Rate,9.29,100% of Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS RATE ,36.58,354.54% OF CMS OPPS RATE,44.24,428.7% of CMS OPPS Rate,46.52,450.81% of CMS OPPS Rate,9.29,100% of WV Medicaid Fee Schedule,10.32,100% of CMS OPPS Rate,10.32,100% of CMS OPPS Rate,8.15,14% of Total Billed Charges,8.15,46.52,29.12
Outpatient Medical Services,LAB,87147,STL,300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,5.18,100% of CMS OPPS Rate,4.66,100% of Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS RATE ,18.36,354.54% OF CMS OPPS RATE,22.2,428.7% of CMS OPPS Rate,23.35,450.81% of CMS OPPS Rate,4.66,100% of WV Medicaid Fee Schedule,5.18,100% of CMS OPPS Rate,5.18,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,4.66,36.12,24.08
Outpatient Medical Services,LAB,87177,Ova + Parasite Exam LC,300,36,27,75% of Total billed charges,27,75% of Total billed charges,8.9,100% of CMS OPPS Rate,8.01,100% of Medicaid Fee Schedule,8.9,100% of CMS OPPS Rate,8.9,100% of CMS OPPS RATE ,31.55,354.54% OF CMS OPPS RATE,38.15,428.7% of CMS OPPS Rate,40.12,450.81% of CMS OPPS Rate,8.01,100% of WV Medicaid Fee Schedule,8.9,100% of CMS OPPS Rate,8.9,100% of CMS OPPS Rate,5.04,14% of Total Billed Charges,5.04,40.12,18.00
Outpatient Medical Services,LAB,87177,Ova + Parasites Stool Conventional,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,8.9,100% of CMS OPPS Rate,8.01,100% of Medicaid Fee Schedule,8.9,100% of CMS OPPS Rate,8.9,100% of CMS OPPS RATE ,31.55,354.54% OF CMS OPPS RATE,38.15,428.7% of CMS OPPS Rate,40.12,450.81% of CMS OPPS Rate,8.01,100% of WV Medicaid Fee Schedule,8.9,100% of CMS OPPS Rate,8.9,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,8.01,56.28,37.52
Outpatient Medical Services,LAB,87185,bLac,300,38.08,28.56,75% of Total billed charges,28.56,75% of Total billed charges,4.75,100% of CMS OPPS Rate,4.28,100% of Medicaid Fee Schedule,4.75,100% of CMS OPPS Rate,4.75,100% of CMS OPPS RATE ,16.84,354.54% OF CMS OPPS RATE,20.36,428.7% of CMS OPPS Rate,21.41,450.81% of CMS OPPS Rate,4.28,100% of WV Medicaid Fee Schedule,4.75,100% of CMS OPPS Rate,4.75,100% of CMS OPPS Rate,5.33,14% of Total Billed Charges,4.28,28.56,19.04
Outpatient Medical Services,LAB,87186,A test used to determine which medications work on bacteria for fungi,300,57.12,42.84,75% of Total billed charges,42.84,75% of Total billed charges,8.65,100% of CMS OPPS Rate,7.79,100% of Medicaid Fee Schedule,8.65,100% of CMS OPPS Rate,8.65,100% of CMS OPPS RATE ,30.66,354.54% OF CMS OPPS RATE,37.08,428.7% of CMS OPPS Rate,38.99,450.81% of CMS OPPS Rate,7.79,100% of WV Medicaid Fee Schedule,8.65,100% of CMS OPPS Rate,8.65,100% of CMS OPPS Rate,8,14% of Total Billed Charges,7.79,42.84,28.56
Outpatient Medical Services,LAB,87186,A test used to determine which medications work on bacteria for fungi,300,64.96,48.72,75% of Total billed charges,48.72,75% of Total billed charges,8.65,100% of CMS OPPS Rate,7.79,100% of Medicaid Fee Schedule,8.65,100% of CMS OPPS Rate,8.65,100% of CMS OPPS RATE ,30.66,354.54% OF CMS OPPS RATE,37.08,428.7% of CMS OPPS Rate,38.99,450.81% of CMS OPPS Rate,7.79,100% of WV Medicaid Fee Schedule,8.65,100% of CMS OPPS Rate,8.65,100% of CMS OPPS Rate,9.09,14% of Total Billed Charges,7.79,48.72,32.48
Outpatient Medical Services,LAB,87205,A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,300,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,4.26,100% of CMS OPPS Rate,3.84,100% of Medicaid Fee Schedule,4.26,100% of CMS OPPS Rate,4.27,100% of CMS OPPS RATE ,15.13,354.54% OF CMS OPPS RATE,18.3,428.7% of CMS OPPS Rate,19.24,450.81% of CMS OPPS Rate,3.84,100% of WV Medicaid Fee Schedule,4.26,100% of CMS OPPS Rate,4.27,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,3.84,58.8,39.20
Outpatient Medical Services,LAB,87205,A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,300,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,4.26,100% of CMS OPPS Rate,3.84,100% of Medicaid Fee Schedule,4.26,100% of CMS OPPS Rate,4.27,100% of CMS OPPS RATE ,15.13,354.54% OF CMS OPPS RATE,18.3,428.7% of CMS OPPS Rate,19.24,450.81% of CMS OPPS Rate,3.84,100% of WV Medicaid Fee Schedule,4.26,100% of CMS OPPS Rate,4.27,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,3.84,58.8,39.20
Outpatient Medical Services,LAB,87207,"Malarial Stain, SO",300,91.84,68.88,75% of Total billed charges,68.88,75% of Total billed charges,5.99,100% of CMS OPPS Rate,5.39,100% of Medicaid Fee Schedule,5.99,100% of CMS OPPS Rate,5.99,100% of CMS OPPS RATE ,21.23,354.54% OF CMS OPPS RATE,25.67,428.7% of CMS OPPS Rate,27,450.81% of CMS OPPS Rate,5.39,100% of WV Medicaid Fee Schedule,5.99,100% of CMS OPPS Rate,5.99,100% of CMS OPPS Rate,12.86,14% of Total Billed Charges,5.39,68.88,45.92
Outpatient Medical Services,LAB,87209,87209 add-on,300,72,54,75% of Total billed charges,54,75% of Total billed charges,17.98,100% of CMS OPPS Rate,16.18,100% of Medicaid Fee Schedule,17.98,100% of CMS OPPS Rate,17.98,100% of CMS OPPS RATE ,63.74,354.54% OF CMS OPPS RATE,77.08,428.7% of CMS OPPS Rate,81.05,450.81% of CMS OPPS Rate,16.18,100% of WV Medicaid Fee Schedule,17.98,100% of CMS OPPS Rate,17.98,100% of CMS OPPS Rate,10.08,14% of Total Billed Charges,10.08,81.05,36.00
Outpatient Medical Services,LAB,87209,Trichrome Smear,306,85.12,63.84,75% of Total billed charges,63.84,75% of Total billed charges,17.98,100% of CMS OPPS Rate,16.18,100% of Medicaid Fee Schedule,17.98,100% of CMS OPPS Rate,17.98,100% of CMS OPPS RATE ,63.74,354.54% OF CMS OPPS RATE,77.08,428.7% of CMS OPPS Rate,81.05,450.81% of CMS OPPS Rate,16.18,100% of WV Medicaid Fee Schedule,17.98,100% of CMS OPPS Rate,17.98,100% of CMS OPPS Rate,11.92,14% of Total Billed Charges,11.92,81.05,42.56
Outpatient Medical Services,LAB,87210,A lab test to screen for evidence of vaginal infection,300,48.16,36.12,75% of Total billed charges,36.12,75% of Total billed charges,5.82,100% of CMS OPPS Rate,5.24,100% of Medicaid Fee Schedule,5.82,100% of CMS OPPS Rate,5.82,100% of CMS OPPS RATE ,20.63,354.54% OF CMS OPPS RATE,24.95,428.7% of CMS OPPS Rate,26.23,450.81% of CMS OPPS Rate,5.24,100% of WV Medicaid Fee Schedule,5.82,100% of CMS OPPS Rate,5.82,100% of CMS OPPS Rate,6.74,14% of Total Billed Charges,5.24,36.12,24.08
Outpatient Medical Services,LAB,87305,Aspergillus Galactomannan Ag,300,580.16,435.12,75% of Total billed charges,435.12,75% of Total billed charges,11.98,100% of CMS OPPS Rate,10.78,100% of Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS RATE ,42.47,354.54% OF CMS OPPS RATE,51.35,428.7% of CMS OPPS Rate,54,450.81% of CMS OPPS Rate,10.78,100% of WV Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS Rate,81.22,14% of Total Billed Charges,10.78,435.12,290.08
Outpatient Medical Services,LAB,87324,A test of the stool to diagnose Clostridium difficile (C. diff) infection,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,11.98,100% of CMS OPPS Rate,10.78,100% of Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS RATE ,42.47,354.54% OF CMS OPPS RATE,51.35,428.7% of CMS OPPS Rate,54,450.81% of CMS OPPS Rate,10.78,100% of WV Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.37,54,26.32
Outpatient Medical Services,LAB,87328,Cryptosporidium/Giardia Immunoassay,300,28,21,75% of Total billed charges,21,75% of Total billed charges,13.82,100% of CMS OPPS Rate,12.44,100% of Medicaid Fee Schedule,13.82,100% of CMS OPPS Rate,13.82,100% of CMS OPPS RATE ,48.99,354.54% OF CMS OPPS RATE,59.24,428.7% of CMS OPPS Rate,62.3,450.81% of CMS OPPS Rate,12.44,100% of WV Medicaid Fee Schedule,13.82,100% of CMS OPPS Rate,13.82,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,3.92,62.3,14.00
Outpatient Medical Services,LAB,87329,Giardia Immunoassay,300,28,21,75% of Total billed charges,21,75% of Total billed charges,11.98,100% of CMS OPPS Rate,10.78,100% of Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS RATE ,42.47,354.54% OF CMS OPPS RATE,51.35,428.7% of CMS OPPS Rate,54,450.81% of CMS OPPS Rate,10.78,100% of WV Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,3.92,54,14.00
Outpatient Medical Services,LAB,87340,"EH Hepatitis Panel, HBsAG",300,42.56,31.92,75% of Total billed charges,31.92,75% of Total billed charges,10.33,100% of CMS OPPS Rate,9.3,100% of Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS RATE ,36.62,354.54% OF CMS OPPS RATE,44.28,428.7% of CMS OPPS Rate,46.56,450.81% of CMS OPPS Rate,9.3,100% of WV Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS Rate,5.96,14% of Total Billed Charges,5.96,46.56,21.28
Outpatient Medical Services,LAB,87340,"Hep VIII, HBsAg",300,69.44,52.08,75% of Total billed charges,52.08,75% of Total billed charges,10.33,100% of CMS OPPS Rate,9.3,100% of Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS RATE ,36.62,354.54% OF CMS OPPS RATE,44.28,428.7% of CMS OPPS Rate,46.56,450.81% of CMS OPPS Rate,9.3,100% of WV Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS Rate,9.72,14% of Total Billed Charges,9.3,52.08,34.72
Outpatient Medical Services,LAB,87340,Hepatitis B Surface - Antigen,300,51.52,38.64,75% of Total billed charges,38.64,75% of Total billed charges,10.33,100% of CMS OPPS Rate,9.3,100% of Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS RATE ,36.62,354.54% OF CMS OPPS RATE,44.28,428.7% of CMS OPPS Rate,46.56,450.81% of CMS OPPS Rate,9.3,100% of WV Medicaid Fee Schedule,10.33,100% of CMS OPPS Rate,10.33,100% of CMS OPPS Rate,7.21,14% of Total Billed Charges,7.21,46.56,25.76
Outpatient Medical Services,LAB,87350,"Hep VIII, HBeAg",300,87.36,65.52,75% of Total billed charges,65.52,75% of Total billed charges,11.53,100% of CMS OPPS Rate,10.38,100% of Medicaid Fee Schedule,11.53,100% of CMS OPPS Rate,11.53,100% of CMS OPPS RATE ,40.87,354.54% OF CMS OPPS RATE,49.42,428.7% of CMS OPPS Rate,51.97,450.81% of CMS OPPS Rate,10.38,100% of WV Medicaid Fee Schedule,11.53,100% of CMS OPPS Rate,11.53,100% of CMS OPPS Rate,12.23,14% of Total Billed Charges,10.38,65.52,43.68
Outpatient Medical Services,LAB,87389,Test for HIV,300,115.36,86.52,75% of Total billed charges,86.52,75% of Total billed charges,24.08,100% of CMS OPPS Rate,21.67,100% of Medicaid Fee Schedule,24.08,100% of CMS OPPS Rate,24.08,100% of CMS OPPS RATE ,85.37,354.54% OF CMS OPPS RATE,103.23,428.7% of CMS OPPS Rate,108.55,450.81% of CMS OPPS Rate,21.67,100% of WV Medicaid Fee Schedule,24.08,100% of CMS OPPS Rate,24.08,100% of CMS OPPS Rate,16.15,14% of Total Billed Charges,16.15,108.55,57.68
Outpatient Medical Services,LAB,87426,COVID Antigen,300,180.32,135.24,75% of Total billed charges,135.24,75% of Total billed charges,35.33,100% of CMS OPPS Rate,N/A,Not Applicable,35.33,100% of CMS OPPS Rate,N/A,Not Applicable,125.25,354.54% OF CMS OPPS RATE,151.45,428.7% of CMS OPPS Rate,159.27,450.81% of CMS OPPS Rate,N/A,Not Applicable,35.33,100% of CMS OPPS Rate,N/A,Not Applicable,25.24,14% of Total Billed Charges,25.24,159.27,90.16
Outpatient Medical Services,LAB,87428,MC SARS/Flu A and B,300,284.88,213.66,75% of Total billed charges,213.66,75% of Total billed charges,N/A,Not Applicable,27.85,100% of Medicaid Fee Schedule,N/A,Not Applicable,30.94,100% of CMS OPPS RATE ,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,27.85,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,30.94,100% of CMS OPPS Rate,39.88,14% of Total Billed Charges,27.85,213.66,142.44
Outpatient Medical Services,LAB,87449,C Diff Antigen Quik Chek Complete,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,11.98,100% of CMS OPPS Rate,10.78,100% of Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS RATE ,42.47,354.54% OF CMS OPPS RATE,51.35,428.7% of CMS OPPS Rate,54,450.81% of CMS OPPS Rate,10.78,100% of WV Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.37,54,26.32
Outpatient Medical Services,LAB,87449,Fungitell (1-3) B-D-Glucan,300,308,231,75% of Total billed charges,231,75% of Total billed charges,11.98,100% of CMS OPPS Rate,10.78,100% of Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS RATE ,42.47,354.54% OF CMS OPPS RATE,51.35,428.7% of CMS OPPS Rate,54,450.81% of CMS OPPS Rate,10.78,100% of WV Medicaid Fee Schedule,11.98,100% of CMS OPPS Rate,11.98,100% of CMS OPPS Rate,43.12,14% of Total Billed Charges,10.78,231,154.00
Outpatient Medical Services,LAB,87481,Candidiasis and Trichomonas Vaginitis,306,156.8,117.6,75% of Total billed charges,117.6,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,21.95,14% of Total Billed Charges,21.95,158.18,78.40
Outpatient Medical Services,LAB,87491,Test that detects Chlamydia,300,155.68,116.76,75% of Total billed charges,116.76,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,21.8,14% of Total Billed Charges,21.8,158.18,77.84
Outpatient Medical Services,LAB,87493,C. difficle-Epi by PCR,300,304.64,228.48,75% of Total billed charges,228.48,75% of Total billed charges,37.27,100% of CMS OPPS Rate,33.54,100% of Medicaid Fee Schedule,37.27,100% of CMS OPPS Rate,37.27,100% of CMS OPPS RATE ,132.13,354.54% OF CMS OPPS RATE,159.77,428.7% of CMS OPPS Rate,168.01,450.81% of CMS OPPS Rate,33.54,100% of WV Medicaid Fee Schedule,37.27,100% of CMS OPPS Rate,37.27,100% of CMS OPPS Rate,42.65,14% of Total Billed Charges,33.54,228.48,152.32
Outpatient Medical Services,LAB,87507,"GI Profile, Stool, PCR LC",300,1016.96,762.72,75% of Total billed charges,762.72,75% of Total billed charges,416.78,100% of CMS OPPS Rate,375.1,100% of Medicaid Fee Schedule,416.78,100% of CMS OPPS Rate,416.78,100% of CMS OPPS RATE ,1477.65,354.54% OF CMS OPPS RATE,1786.73,428.7% of CMS OPPS Rate,1878.88,450.81% of CMS OPPS Rate,375.1,100% of WV Medicaid Fee Schedule,416.78,100% of CMS OPPS Rate,416.78,100% of CMS OPPS Rate,142.37,14% of Total Billed Charges,142.37,1878.88,508.48
Outpatient Medical Services,LAB,87521,"Hepatitis C Virus RNA, Qualitative NAA, SO",300,286.72,215.04,75% of Total billed charges,215.04,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,40.14,14% of Total Billed Charges,31.58,215.04,143.36
Outpatient Medical Services,LAB,87529,"Herpes Simplex Virus I/II DNA PCR, SO",300,297.92,223.44,75% of Total billed charges,223.44,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,41.71,14% of Total Billed Charges,31.58,223.44,148.96
Outpatient Medical Services,LAB,87529,"HSV II, DNA, PCR",300,297.92,223.44,75% of Total billed charges,223.44,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,41.71,14% of Total Billed Charges,31.58,223.44,148.96
Outpatient Medical Services,LAB,87591,Blood test for an STD,300,161.28,120.96,75% of Total billed charges,120.96,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,22.58,14% of Total Billed Charges,22.58,158.18,80.64
Outpatient Medical Services,LAB,87631,Flu/RSV by PCR,300,512.96,384.72,75% of Total billed charges,384.72,75% of Total billed charges,142.63,100% of CMS OPPS Rate,128.37,100% of Medicaid Fee Schedule,142.63,100% of CMS OPPS Rate,142.63,100% of CMS OPPS RATE ,505.68,354.54% OF CMS OPPS RATE,611.45,428.7% of CMS OPPS Rate,642.99,450.81% of CMS OPPS Rate,128.37,100% of WV Medicaid Fee Schedule,142.63,100% of CMS OPPS Rate,142.63,100% of CMS OPPS Rate,71.81,14% of Total Billed Charges,71.81,642.99,256.48
Outpatient Medical Services,LAB,87641,MRSA by PCR Nasal,300,187.04,140.28,75% of Total billed charges,140.28,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,26.19,14% of Total Billed Charges,26.19,158.18,93.52
Outpatient Medical Services,LAB,87661,Blood test for an STD,306,156.8,117.6,75% of Total billed charges,117.6,75% of Total billed charges,35.09,100% of CMS OPPS Rate,31.58,100% of Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS RATE ,124.4,354.54% OF CMS OPPS RATE,150.43,428.7% of CMS OPPS Rate,158.18,450.81% of CMS OPPS Rate,31.58,100% of WV Medicaid Fee Schedule,35.09,100% of CMS OPPS Rate,35.09,100% of CMS OPPS Rate,21.95,14% of Total Billed Charges,21.95,158.18,78.40
Outpatient Medical Services,LAB,87804,Flu test,300,112,84,75% of Total billed charges,84,75% of Total billed charges,16.55,100% of CMS OPPS Rate,14.9,100% of Medicaid Fee Schedule,16.55,100% of CMS OPPS Rate,16.55,100% of CMS OPPS RATE ,58.67,354.54% OF CMS OPPS RATE,70.94,428.7% of CMS OPPS Rate,74.6,450.81% of CMS OPPS Rate,14.9,100% of WV Medicaid Fee Schedule,16.55,100% of CMS OPPS Rate,16.55,100% of CMS OPPS Rate,15.68,14% of Total Billed Charges,14.9,84,56.00
Outpatient Medical Services,LAB,87807,Test for RSV,300,58.69,44.02,75% of Total billed charges,44.02,75% of Total billed charges,13.1,100% of CMS OPPS Rate,11.79,100% of Medicaid Fee Schedule,13.1,100% of CMS OPPS Rate,13.1,100% of CMS OPPS RATE ,46.44,354.54% OF CMS OPPS RATE,56.15,428.7% of CMS OPPS Rate,59.05,450.81% of CMS OPPS Rate,11.79,100% of WV Medicaid Fee Schedule,13.1,100% of CMS OPPS Rate,13.1,100% of CMS OPPS Rate,8.22,14% of Total Billed Charges,8.22,59.05,29.35
Outpatient Medical Services,LAB,87880,Test for strep A,300,77.28,57.96,75% of Total billed charges,57.96,75% of Total billed charges,16.53,100% of CMS OPPS Rate,14.88,100% of Medicaid Fee Schedule,16.53,100% of CMS OPPS Rate,16.53,100% of CMS OPPS RATE ,58.6,354.54% OF CMS OPPS RATE,70.86,428.7% of CMS OPPS Rate,74.51,450.81% of CMS OPPS Rate,14.88,100% of WV Medicaid Fee Schedule,16.53,100% of CMS OPPS Rate,16.53,100% of CMS OPPS Rate,10.82,14% of Total Billed Charges,10.82,74.51,38.64
Outpatient Medical Services,LAB,87880,Test for strep A,300,77.28,57.96,75% of Total billed charges,57.96,75% of Total billed charges,16.53,100% of CMS OPPS Rate,14.88,100% of Medicaid Fee Schedule,16.53,100% of CMS OPPS Rate,16.53,100% of CMS OPPS RATE ,58.6,354.54% OF CMS OPPS RATE,70.86,428.7% of CMS OPPS Rate,74.51,450.81% of CMS OPPS Rate,14.88,100% of WV Medicaid Fee Schedule,16.53,100% of CMS OPPS Rate,16.53,100% of CMS OPPS Rate,10.82,14% of Total Billed Charges,10.82,74.51,38.64
Outpatient Medical Services,LAB,87899,Legionella Antigen,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,16.07,100% of CMS OPPS Rate,14.46,100% of Medicaid Fee Schedule,16.07,100% of CMS OPPS Rate,16.07,100% of CMS OPPS RATE ,56.97,354.54% OF CMS OPPS RATE,68.89,428.7% of CMS OPPS Rate,72.44,450.81% of CMS OPPS Rate,14.46,100% of WV Medicaid Fee Schedule,16.07,100% of CMS OPPS Rate,16.07,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.37,72.44,26.32
Outpatient Medical Services,LAB,87899,Strep Pneumo Antigen,300,52.64,39.48,75% of Total billed charges,39.48,75% of Total billed charges,16.07,100% of CMS OPPS Rate,14.46,100% of Medicaid Fee Schedule,16.07,100% of CMS OPPS Rate,16.07,100% of CMS OPPS RATE ,56.97,354.54% OF CMS OPPS RATE,68.89,428.7% of CMS OPPS Rate,72.44,450.81% of CMS OPPS Rate,14.46,100% of WV Medicaid Fee Schedule,16.07,100% of CMS OPPS Rate,16.07,100% of CMS OPPS Rate,7.37,14% of Total Billed Charges,7.37,72.44,26.32
Outpatient Medical Services,LAB,89051,BF Count and Dif,300,172.48,129.36,75% of Total billed charges,129.36,75% of Total billed charges,5.6,100% of CMS OPPS Rate,5.04,100% of Medicaid Fee Schedule,5.6,100% of CMS OPPS Rate,5.6,100% of CMS OPPS RATE ,19.85,354.54% OF CMS OPPS RATE,24,428.7% of CMS OPPS Rate,25.24,450.81% of CMS OPPS Rate,5.04,100% of WV Medicaid Fee Schedule,5.6,100% of CMS OPPS Rate,5.6,100% of CMS OPPS Rate,24.15,14% of Total Billed Charges,5.04,129.36,86.24
Outpatient Medical Services,LAB,89051,CSF Count and Dif,300,172.48,129.36,75% of Total billed charges,129.36,75% of Total billed charges,5.6,100% of CMS OPPS Rate,5.04,100% of Medicaid Fee Schedule,5.6,100% of CMS OPPS Rate,5.6,100% of CMS OPPS RATE ,19.85,354.54% OF CMS OPPS RATE,24,428.7% of CMS OPPS Rate,25.24,450.81% of CMS OPPS Rate,5.04,100% of WV Medicaid Fee Schedule,5.6,100% of CMS OPPS Rate,5.6,100% of CMS OPPS Rate,24.15,14% of Total Billed Charges,5.04,129.36,86.24
Outpatient Medical Services,LAB,89060,Crystals Body Fluid,300,75.04,56.28,75% of Total billed charges,56.28,75% of Total billed charges,7.33,100% of CMS OPPS Rate,6.6,100% of Medicaid Fee Schedule,7.33,100% of CMS OPPS Rate,7.33,100% of CMS OPPS RATE ,25.98,354.54% OF CMS OPPS RATE,31.42,428.7% of CMS OPPS Rate,33.04,450.81% of CMS OPPS Rate,6.6,100% of WV Medicaid Fee Schedule,7.33,100% of CMS OPPS Rate,7.33,100% of CMS OPPS Rate,10.51,14% of Total Billed Charges,6.6,56.28,37.52
Outpatient Medical Services,LAB,0241U,Biofire Respiratory Panel,310,639.52,479.64,75% of Total billed charges,479.64,75% of Total billed charges,142.63,100% of CMS OPPS Rate,N/A,Not Applicable,142.63,100% of CMS OPPS Rate,142.63,100% of CMS OPPS RATE ,505.68,354.54% OF CMS OPPS RATE,611.45,428.7% of CMS OPPS Rate,642.99,450.81% of CMS OPPS Rate,N/A,Not Applicable,142.63,100% of CMS OPPS Rate,142.63,100% of CMS OPPS Rate,89.53,14% of Total Billed Charges,89.53,642.99,319.76
Outpatient Medical Services,LAB,G0103,Prostate cancer screening; prostate specific antigen test (psa),300,109.76,82.32,75% of Total billed charges,82.32,75% of Total billed charges,19.3,100% of CMS OPPS Rate,N/A,Not Applicable,19.3,100% of CMS OPPS Rate,19.31,100% of CMS OPPS RATE ,68.46,354.54% OF CMS OPPS RATE,82.78,428.7% of CMS OPPS Rate,87.05,450.81% of CMS OPPS Rate,N/A,Not Applicable,19.3,100% of CMS OPPS Rate,19.31,100% of CMS OPPS Rate,15.37,14% of Total Billed Charges,15.37,87.05,54.88
Outpatient Medical Services,LAB,G2023,Specimen Collect Covid-19,300,28,21,75% of Total billed charges,21,75% of Total billed charges,2.04,100% of CMS OPPS Rate,N/A,Not Applicable,3.37,165% of CMS OPPS Rate,25.45,100% of CMS OPPS RATE ,7.23,354.54% OF CMS OPPS RATE,8.75,428.7% of CMS OPPS Rate,9.2,450.81% of CMS OPPS Rate,N/A,Not Applicable,2.04,100% of CMS OPPS Rate,25.45,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,2.04,25.45,14.00
Outpatient Medical Services,LAB,G2023,Specimen Collect Covid-19,300,28,21,75% of Total billed charges,21,75% of Total billed charges,2.04,100% of CMS OPPS Rate,N/A,Not Applicable,3.37,165% of CMS OPPS Rate,25.45,100% of CMS OPPS RATE ,7.23,354.54% OF CMS OPPS RATE,8.75,428.7% of CMS OPPS Rate,9.2,450.81% of CMS OPPS Rate,N/A,Not Applicable,2.04,100% of CMS OPPS Rate,25.45,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,2.04,25.45,14.00
Outpatient Medical Services,LAB,P9016,Apheresis RBC CP2D AS3 LR 2nd Cont,390,782.82,587.12,75% of Total billed charges,587.12,75% of Total billed charges,189.21,100% of CMS OPPS Rate,N/A,Not Applicable,312.19,165% of CMS OPPS Rate,210.02,111% CMS OPPS Rate,582.04,307.63% of CMS OPPS RATE,798.25,421.89% of CMS OPPS Rate,999.89,258.46% of CMS OPPS Rate,N/A,Not Applicable,189.21,100% of CMS OPPS Rate,210.02,111% of CMS OPPS Rate ,109.59,14% of Total Billed Charges,109.59,999.89,391.41
Outpatient Medical Services,LAB,P9016,RBC CPD AS1 LR 500 ml,390,782.82,587.12,75% of Total billed charges,587.12,75% of Total billed charges,189.21,100% of CMS OPPS Rate,N/A,Not Applicable,312.19,165% of CMS OPPS Rate,210.02,111% CMS OPPS Rate,582.04,307.63% of CMS OPPS RATE,798.25,421.89% of CMS OPPS Rate,999.89,258.46% of CMS OPPS Rate,N/A,Not Applicable,189.21,100% of CMS OPPS Rate,210.02,111% of CMS OPPS Rate ,109.59,14% of Total Billed Charges,109.59,999.89,391.41
Outpatient Medical Services,LAB,36415,Collection of venous blood by venipuncture,300,12.32,9.24,75% of Total billed charges,9.24,75% of Total billed charges,8.57,100% of CMS OPPS Rate,3,100% of Medicaid Fee Schedule,8.57,100% of CMS OPPS Rate,3,100% of CMS OPPS RATE ,30.38,354.54% OF CMS OPPS RATE,36.73,428.7% of CMS OPPS Rate,38.63,450.81% of CMS OPPS Rate,3,100% of WV Medicaid Fee Schedule,8.57,100% of CMS OPPS Rate,3,100% of CMS OPPS Rate,1.72,14% of Total Billed Charges,1.72,38.63,6.16
Outpatient Medical Services,LAB,36416,Capillary,300,16.8,12.6,75% of Total billed charges,12.6,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,2.35,14% of Total Billed Charges,2.35,12.6,8.40
Outpatient Medical Services,LAB,36430,BB Administration Charge,391,1740.85,1305.64,75% of Total billed charges,1305.64,75% of Total billed charges,383.34,100% of CMS OPPS Rate,30.3,102% of Medicaid Fee Schedule,632.52,165% of CMS OPPS Rate,397.31,111% CMS OPPS Rate,1101.11,307.63% of CMS OPPS RATE,1510.1,421.89% of CMS OPPS Rate,1891.56,258.46% of CMS OPPS Rate,29.71,100% of WV Medicaid Fee Schedule,383.34,100% of CMS OPPS Rate,397.31,111% of CMS OPPS Rate ,243.72,14% of Total Billed Charges,29.71,1891.56,870.43
Outpatient Medical Services,LAB,36600,Arterial Draw,300,498.14,373.61,75% of Total billed charges,373.61,75% of Total billed charges,109.16,100% of CMS OPPS Rate,N/A,Not Applicable,180.11,165% of CMS OPPS Rate,113.13,111% CMS OPPS Rate,313.55,307.63% of CMS OPPS RATE,430.01,421.89% of CMS OPPS Rate,538.63,258.46% of CMS OPPS Rate,N/A,Not Applicable,109.16,100% of CMS OPPS Rate,113.13,111% of CMS OPPS Rate ,69.74,14% of Total Billed Charges,69.74,538.63,249.07
Outpatient Medical Services,LAB,U0004,Sars CoV 2 by PCR,300,84,63,75% of Total billed charges,63,75% of Total billed charges,N/A,Not Applicable,67.5,100% of Medicaid Fee Schedule,N/A,Not Applicable,75,100% of CMS OPPS RATE ,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,67.5,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,75,100% of CMS OPPS Rate,11.76,14% of Total Billed Charges,11.76,75,42.00
Outpatient Medical Services,LAB,U0005,U0005-COVID Comp within 2 Days,300,28,21,75% of Total billed charges,21,75% of Total billed charges,N/A,Not Applicable,22.5,100% of Medicaid Fee Schedule,N/A,Not Applicable,25,100% of CMS OPPS RATE ,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,22.5,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,25,100% of CMS OPPS Rate,3.92,14% of Total Billed Charges,3.92,25,14.00
Outpatient Medical Services,VISIT,99203,"New patient office or other outpatient visit, typically 30 min",510,190.4,142.8,75% of Total billed charges,142.8,75% of Total billed charges,N/A,Not Applicable,58.25,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,58.25,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,26.66,14% of Total Billed Charges,26.66,142.8,95.20
Outpatient Medical Services,VISIT,99204,"New patient office of other outpatient visit, typically 45 min",510,190.4,142.8,75% of Total billed charges,142.8,75% of Total billed charges,N/A,Not Applicable,94.39,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,94.39,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,26.66,14% of Total Billed Charges,26.66,142.8,95.20
Outpatient Medical Services,VISIT,99205,"New patient office of other outpatient visit, typically 60 min",510,190.4,142.8,75% of Total billed charges,142.8,75% of Total billed charges,N/A,Not Applicable,127.82,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,127.82,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,26.66,14% of Total Billed Charges,26.66,142.8,95.20
Outpatient Medical Services,VISIT,99244,"Patient office consultation, typically 60 min",510,508.48,381.36,75% of Total billed charges,381.36,75% of Total billed charges,N/A,Not Applicable,105.69,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,105.69,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,71.19,14% of Total Billed Charges,71.19,381.36,254.24
Outpatient Medical Services,RADIOLOGY,Q9963,Gastroview -1ml,636,2,1.5,75% of Total billed charges,1.5,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,0.28,14% of Total Billed Charges,0.28,1.5,1.00
Outpatient Medical Services,RADIOLOGY,Q9967,CT Isovue 370 1-mL,255,3.54,2.66,75% of Total billed charges,2.66,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,0.5,14% of Total Billed Charges,0.5,2.66,1.77
Outpatient Medical Services,RADIOLOGY,Q9967,DR Isovue 300-1ml,636,4.75,3.56,75% of Total billed charges,3.56,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,0.67,14% of Total Billed Charges,0.67,3.56,2.38
Outpatient Medical Services,RADIOLOGY,Q9967,DR Optiray 320-1ml,250,2,1.5,75% of Total billed charges,1.5,75% of Total billed charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,0.28,14% of Total Billed Charges,0.28,1.5,1.00
Outpatient Medical Services,RADIOLOGY,70220,Sinus Series,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,24.58,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,24.58,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,24.58,403.03,168.08
Outpatient Medical Services,RADIOLOGY,70360,Soft Tissue Neck,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.39,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.39,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.39,403.03,168.08
Outpatient Medical Services,RADIOLOGY,70450,CT scan head or brain without dye,351,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,72.27,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,72.27,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,70460,CT Head ENH,351,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,101.52,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,101.52,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,101.52,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70470,CT Head UN and ENH,351,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,119.21,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,119.21,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70486,CT Scan of the face and jaw without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,87.01,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,87.01,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,70487,CT Maxillofacial ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,103.97,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,103.97,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70490,CT Neck Soft Tissue UN,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,103.48,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,103.48,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,70491,CT scan of neck with dye,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,126.83,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,126.83,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70496,CTA Head ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,170.13,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,170.13,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70498,CTA Neck Soft Tissue ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,170.13,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,170.13,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,611,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,220.48,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,220.48,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,214.24,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,71045,Single view,324,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.67,100% of CMS OPPS Rate,16.96,100% of Medicaid Fee Schedule,134.76,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.75,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,16.96,100% of WV Medicaid Fee Schedule,81.67,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,16.96,403.03,168.08
Outpatient Medical Services,RADIOLOGY,71046,"2 views, front and back",324,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.67,100% of CMS OPPS Rate,21.88,100% of Medicaid Fee Schedule,134.76,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.75,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.88,100% of WV Medicaid Fee Schedule,81.67,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.88,403.03,168.08
Outpatient Medical Services,RADIOLOGY,71100,Ribs Lt after PCXR performed,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,24.09,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,24.09,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,24.09,403.03,168.08
Outpatient Medical Services,RADIOLOGY,71100,Ribs Rt after PCXR performed,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,24.09,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,24.09,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,24.09,403.03,168.08
Outpatient Medical Services,RADIOLOGY,71101,Radiologic examination of one side of the chest/ribs,320,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,27.53,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,27.53,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,27.53,495.81,226.22
Outpatient Medical Services,RADIOLOGY,71101,Radiologic examination of one side of the chest/ribs,320,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,27.53,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,27.53,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,27.53,495.81,226.22
Outpatient Medical Services,RADIOLOGY,71111,Ribs Bilat min 4 with PA Chest,320,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,34.4,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,34.4,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,34.4,495.81,226.22
Outpatient Medical Services,RADIOLOGY,71120,Sternum min 2 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.12,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.12,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.12,403.03,168.08
Outpatient Medical Services,RADIOLOGY,71250,CT scan of the thorax without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,90.95,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,90.95,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,71260,CT scan of the thorax with dye,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,113.56,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,113.56,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,71275,Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,172.48,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,172.48,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,71275,Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,172.48,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,172.48,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,71275,Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,172.48,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,172.48,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,72040,"Radiologic examination of the neck/spine, 2-3 views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,25.81,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,25.81,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,25.81,403.03,168.08
Outpatient Medical Services,RADIOLOGY,72050,"Radiologic examination of the neck/spine, 4-5 views",320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,34.65,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,34.65,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,34.65,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72070,"Radiologic examination of the middle spine, 2 views",320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,21.38,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,21.38,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,21.38,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72072,"Radiologic examination of the middle spine, 3 views",320,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,25.56,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,25.56,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,25.56,495.81,226.22
Outpatient Medical Services,RADIOLOGY,72100,X-ray of the lower spine 2-3 views,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,26.05,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,26.05,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,26.05,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72110,"X-ray of lower and sacral spine, minimum of 4 views",320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,33.18,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,33.18,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,33.18,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72125,CT Cervical Spine Routine UN,350,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,88.98,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,88.98,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72126,CT Cervical Spine ENH,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,115.77,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,115.77,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,115.77,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,72128,CT Thoracic Spine Routine UN,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,88.73,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,88.73,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,72131,CT scan of lower spine without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,88.49,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,88.49,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal,612,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,132.49,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,132.49,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,132.49,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,72170,Radiologic examination of the pelvis,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,18.19,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,18.19,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,18.19,495.81,240.57
Outpatient Medical Services,RADIOLOGY,72192,CT of pelvis without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,91.19,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,91.19,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,72192,CT of pelvis without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,91.19,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,91.19,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,150.07,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,150.07,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,72220,Sacrum and Coccyx,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,21.14,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.14,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.14,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73000,Radiologic examination of the collar bone,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.89,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.89,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.89,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73000,Radiologic examination of the collar bone,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.89,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.89,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.89,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73020,Shoulder Rt one view,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,14.01,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,14.01,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,14.01,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73030,Radiologic examination of the shoulder,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.37,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.37,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.37,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73030,Radiologic examination of the shoulder,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.37,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.37,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.37,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73060,Humerus Lt,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.65,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.65,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.65,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73060,Humerus Rt,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.65,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.65,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.65,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73070,"Radiologic examination, elbow; 2 views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73070,"Radiologic examination, elbow; 2 views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73080,"Radiologic examination, elbow; 3 or more views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,21.14,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.14,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.14,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73080,"Radiologic examination, elbow; 3 or more views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,21.14,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.14,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.14,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73090,Radiologic examination of the forearm,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73090,Radiologic examination of the forearm,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73100,3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,21.88,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.88,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.88,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73100,3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,21.88,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,21.88,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,21.88,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73110,Up to 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,26.3,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,26.3,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,26.3,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73110,Up to 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,26.3,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,26.3,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,26.3,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73120,X-ray of the hand with 2 views,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,20.16,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,20.16,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,20.16,495.81,240.57
Outpatient Medical Services,RADIOLOGY,73120,X-ray of the hand with 2 views,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,20.16,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,20.16,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,20.16,495.81,240.57
Outpatient Medical Services,RADIOLOGY,73130,X-ray of the hand with 3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,23.6,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,23.6,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,23.6,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73130,X-ray of the hand with 3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,23.6,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,23.6,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,23.6,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73140,Radiologic examination of the finger(s),320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,24.09,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,24.09,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,24.09,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73140,Radiologic examination of the finger(s),320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,24.09,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,24.09,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,24.09,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73200,CT Elbow Rt Routine UN,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,101.43,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,101.43,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,73201,CT Hand Rt ENH,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,137.16,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,137.16,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,137.16,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,73502,Hip Lt Routine 2 view,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,30.48,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,30.48,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,30.48,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73502,Hip Rt Routine 2 view,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,30.48,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,30.48,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,30.48,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73502,Pelvis and Lt Hip 2-3 vws,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,30.48,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,30.48,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,30.48,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73502,Pelvis and Rt Hip 2-3 vws,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,30.48,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,30.48,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,30.48,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73521,Hips Bilat,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,26.79,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,26.79,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,26.79,495.81,240.57
Outpatient Medical Services,RADIOLOGY,73552,Femur Lt,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.86,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.86,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.86,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73552,Femur Rt,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.86,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.86,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.86,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73560,Radiologic examination of the knee with 1 or 2 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.12,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.12,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.12,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73560,Radiologic examination of the knee with 1 or 2 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.12,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.12,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.12,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73562,Radiologic examination of the knee with 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,26.55,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,26.55,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,26.55,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73562,Radiologic examination of the knee with 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,26.55,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,26.55,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,26.55,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73564,Radiologic examination of the knee with 4 or more views,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,29.99,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,29.99,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,29.99,495.81,240.57
Outpatient Medical Services,RADIOLOGY,73564,Radiologic examination of the knee with 4 or more views,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,29.99,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,29.99,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,29.99,495.81,240.57
Outpatient Medical Services,RADIOLOGY,73590,Radiologic examination of the lower leg,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.39,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.39,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.39,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73590,Radiologic examination of the lower leg,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.39,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.39,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.39,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73600,Radiologic examination of the ankle with 2 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.89,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.89,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.89,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73600,Radiologic examination of the ankle with 2 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,20.89,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,20.89,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,20.89,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73610,Radiologic examination of the ankle with 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,23.84,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,23.84,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,23.84,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73610,Radiologic examination of the ankle with 3 views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,23.84,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,23.84,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,23.84,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73620,"Radiologic examination, foot; 2 views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.44,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.44,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.44,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73620,"Radiologic examination, foot; 2 views",320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.44,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.44,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.44,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73630,Radiologic examination of the foot with 3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.37,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.37,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.37,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73630,Radiologic examination of the foot with 3 or more views,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,22.37,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,22.37,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,22.37,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73660,Radiologic examination of the toe(s),320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73660,Radiologic examination of the toe(s),320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,18.93,100% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,18.93,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,18.93,403.03,168.08
Outpatient Medical Services,RADIOLOGY,73700,CT scan of leg without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,88.49,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,88.49,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,73700,CT scan of leg without dye,350,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,88.49,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,88.49,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,73701,CT Femur RT ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,113.81,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,113.81,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,73701,CT Foot RT ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,113.81,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,113.81,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,73701,CT Tib Fib RT ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,113.81,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,113.81,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,73721,MRI of lower extremity joint (knee/ankle) without dye,610,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,139.12,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,139.12,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,133.87,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,74018,Abdomen AP,320,336.15,252.11,75% of Total billed charges,252.11,75% of Total billed charges,81.68,100% of CMS OPPS Rate,19.66,102% of Medicaid Fee Schedule,134.77,165% of CMS OPPS Rate,84.65,111% CMS OPPS Rate,234.61,307.63% of CMS OPPS RATE,321.76,421.89% of CMS OPPS Rate,403.03,258.46% of CMS OPPS Rate,19.66,100% of WV Medicaid Fee Schedule,81.68,100% of CMS OPPS Rate,84.65,111% of CMS OPPS Rate ,47.06,14% of Total Billed Charges,19.66,403.03,168.08
Outpatient Medical Services,RADIOLOGY,74019,Abdomen Flat and Uprt No Chest,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,24.09,102% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,24.09,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,24.09,495.81,240.57
Outpatient Medical Services,RADIOLOGY,74022,Serial radiologic examination of the abdomen,320,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,32.69,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,32.69,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,32.69,495.81,240.57
Outpatient Medical Services,RADIOLOGY,74160,CT of abdomen with dye,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.55,100% of CMS OPPS Rate,154.21,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.71,111% CMS OPPS Rate,486.99,307.63% of CMS OPPS RATE,667.88,421.89% of CMS OPPS Rate,836.59,258.46% of CMS OPPS Rate,154.21,100% of WV Medicaid Fee Schedule,169.55,100% of CMS OPPS Rate,175.71,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.59,371.15
Outpatient Medical Services,RADIOLOGY,74174,CTA Abdomen Pelvis ENH,350,1615.45,1211.59,75% of Total billed charges,1211.59,75% of Total billed charges,346.38,100% of CMS OPPS Rate,260.55,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,260.55,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,226.16,14% of Total Billed Charges,226.16,1709.15,807.73
Outpatient Medical Services,RADIOLOGY,74176,CT of abdomen and pelvis without dye,350,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,126.34,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,126.34,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,126.34,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,74176,CT of abdomen and pelvis without dye,350,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,126.34,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,126.34,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,126.34,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,74176,CT of abdomen and pelvis without dye,350,956.2,717.15,75% of Total billed charges,717.15,75% of Total billed charges,219.54,100% of CMS OPPS Rate,126.34,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,126.34,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,133.87,14% of Total Billed Charges,126.34,1083.29,478.10
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,210.4,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,210.4,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,210.4,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,74178,"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections ",350,1530.3,1147.73,75% of Total billed charges,1147.73,75% of Total billed charges,346.38,100% of CMS OPPS Rate,235.23,100% of Medicaid Fee Schedule,571.51,165% of CMS OPPS Rate,358.99,111% CMS OPPS Rate,994.94,307.63% of CMS OPPS RATE,1364.48,421.89% of CMS OPPS Rate,1709.15,258.46% of CMS OPPS Rate,235.23,100% of WV Medicaid Fee Schedule,346.38,100% of CMS OPPS Rate,358.99,111% of CMS OPPS Rate ,214.24,14% of Total Billed Charges,214.24,1709.15,765.15
Outpatient Medical Services,RADIOLOGY,75635,CTA Aorta Runoff ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.54,100% of CMS OPPS Rate,190.62,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.72,111% CMS OPPS Rate,487,307.63% of CMS OPPS RATE,667.89,421.89% of CMS OPPS Rate,836.6,258.46% of CMS OPPS Rate,190.62,100% of WV Medicaid Fee Schedule,169.54,100% of CMS OPPS Rate,175.72,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.6,371.15
Outpatient Medical Services,RADIOLOGY,75635,CTA Aorta Runoff UN and ENH,350,742.3,556.73,75% of Total billed charges,556.73,75% of Total billed charges,169.54,100% of CMS OPPS Rate,190.62,100% of Medicaid Fee Schedule,279.75,165% of CMS OPPS Rate,175.72,111% CMS OPPS Rate,487,307.63% of CMS OPPS RATE,667.89,421.89% of CMS OPPS Rate,836.6,258.46% of CMS OPPS Rate,190.62,100% of WV Medicaid Fee Schedule,169.54,100% of CMS OPPS Rate,175.72,111% of CMS OPPS Rate ,103.92,14% of Total Billed Charges,103.92,836.6,371.15
Outpatient Medical Services,RADIOLOGY,76536,Ultrasound of head and neck,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,73.48,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,73.48,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen with all areas scanned,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen with all areas scanned,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen with all areas scanned,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen with all areas scanned,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76705,A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,58.25,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,58.25,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,58.25,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76705,A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,58.25,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,58.25,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,58.25,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76770,Ultrasound of back wall of the abdomen with all areas viewed,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,72.02,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,72.02,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.16,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.16,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.16,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.16,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,89.23,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,89.23,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,89.23,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,89.23,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,RADIOLOGY,76815,Ultrasound of fetus with limited views,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,54.08,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,54.08,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,54.08,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76815,Ultrasound of fetus with limited views,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,54.08,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,54.08,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,54.08,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76816,US Pelvic OB Follow Up,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,72.76,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,72.76,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76817,Transvaginal ultrasound of uterus,402,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,61.94,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,61.94,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,61.94,495.81,226.22
Outpatient Medical Services,RADIOLOGY,76817,Transvaginal ultrasound of uterus,402,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,61.94,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,61.94,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,61.94,495.81,226.22
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound of the pelvis through vagina,,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,78.9,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,78.9,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76856,Complete ultrasound of the pelvis,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,70.05,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,70.05,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76857,Limited ultrasound of the pelvis,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,31.95,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,31.95,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,31.95,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76857,Limited ultrasound of the pelvis,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,31.95,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,31.95,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,31.95,495.81,240.57
Outpatient Medical Services,RADIOLOGY,76870,Ultrasound of the scrotum,402,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,66.86,100% of Medicaid Fee Schedule,165.8,165% of CMS OPPS Rate,104.14,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.83,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,66.86,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.14,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,66.86,495.81,240.57
Outpatient Medical Services,RADIOLOGY,77065,"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",401,552.16,414.12,75% of Total billed charges,414.12,75% of Total billed charges,76.49,100% of CMS OPPS Rate,82.59,100% of Medicaid Fee Schedule,126.21,165% of CMS OPPS Rate,111.32,100% of CMS OPPS RATE ,271.19,354.54% OF CMS OPPS RATE,327.91,428.7% of CMS OPPS Rate,344.82,450.81% of CMS OPPS Rate,82.59,100% of WV Medicaid Fee Schedule,76.49,100% of CMS OPPS Rate,111.32,100% of CMS OPPS Rate,77.3,14% of Total Billed Charges,76.49,414.12,276.08
Outpatient Medical Services,RADIOLOGY,77065,"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",401,552.16,414.12,75% of Total billed charges,414.12,75% of Total billed charges,76.49,100% of CMS OPPS Rate,82.59,100% of Medicaid Fee Schedule,126.21,165% of CMS OPPS Rate,111.32,100% of CMS OPPS RATE ,271.19,354.54% OF CMS OPPS RATE,327.91,428.7% of CMS OPPS Rate,344.82,450.81% of CMS OPPS Rate,82.59,100% of WV Medicaid Fee Schedule,76.49,100% of CMS OPPS Rate,111.32,100% of CMS OPPS Rate,77.3,14% of Total Billed Charges,76.49,414.12,276.08
Outpatient Medical Services,RADIOLOGY,77065,"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",401,552.16,414.12,75% of Total billed charges,414.12,75% of Total billed charges,76.49,100% of CMS OPPS Rate,82.59,100% of Medicaid Fee Schedule,126.21,165% of CMS OPPS Rate,111.32,100% of CMS OPPS RATE ,271.19,354.54% OF CMS OPPS RATE,327.91,428.7% of CMS OPPS Rate,344.82,450.81% of CMS OPPS Rate,82.59,100% of WV Medicaid Fee Schedule,76.49,100% of CMS OPPS Rate,111.32,100% of CMS OPPS Rate,77.3,14% of Total Billed Charges,76.49,414.12,276.08
Outpatient Medical Services,RADIOLOGY,77065,"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",401,552.16,414.12,75% of Total billed charges,414.12,75% of Total billed charges,76.49,100% of CMS OPPS Rate,82.59,100% of Medicaid Fee Schedule,126.21,165% of CMS OPPS Rate,111.32,100% of CMS OPPS RATE ,271.19,354.54% OF CMS OPPS RATE,327.91,428.7% of CMS OPPS Rate,344.82,450.81% of CMS OPPS Rate,82.59,100% of WV Medicaid Fee Schedule,76.49,100% of CMS OPPS Rate,111.32,100% of CMS OPPS Rate,77.3,14% of Total Billed Charges,76.49,414.12,276.08
Outpatient Medical Services,RADIOLOGY,77066,"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral",401,696.64,522.48,75% of Total billed charges,522.48,75% of Total billed charges,97.47,100% of CMS OPPS Rate,104.22,100% of Medicaid Fee Schedule,160.83,165% of CMS OPPS Rate,140.06,100% of CMS OPPS RATE ,345.57,354.54% OF CMS OPPS RATE,417.85,428.7% of CMS OPPS Rate,439.4,450.81% of CMS OPPS Rate,104.22,100% of WV Medicaid Fee Schedule,97.47,100% of CMS OPPS Rate,140.06,100% of CMS OPPS Rate,97.53,14% of Total Billed Charges,97.47,522.48,348.32
Outpatient Medical Services,RADIOLOGY,77066,"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral",401,696.64,522.48,75% of Total billed charges,522.48,75% of Total billed charges,97.47,100% of CMS OPPS Rate,104.22,100% of Medicaid Fee Schedule,160.83,165% of CMS OPPS Rate,140.06,100% of CMS OPPS RATE ,345.57,354.54% OF CMS OPPS RATE,417.85,428.7% of CMS OPPS Rate,439.4,450.81% of CMS OPPS Rate,104.22,100% of WV Medicaid Fee Schedule,97.47,100% of CMS OPPS Rate,140.06,100% of CMS OPPS Rate,97.53,14% of Total Billed Charges,97.47,522.48,348.32
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,77067,Mammography of both breasts-2 or more views,403,560,420,75% of Total billed charges,420,75% of Total billed charges,80.86,100% of CMS OPPS Rate,83.82,100% of Medicaid Fee Schedule,133.42,165% of CMS OPPS Rate,113.65,100% of CMS OPPS RATE ,286.68,354.54% OF CMS OPPS RATE,346.65,428.7% of CMS OPPS Rate,364.52,450.81% of CMS OPPS Rate,83.82,100% of WV Medicaid Fee Schedule,80.86,100% of CMS OPPS Rate,113.65,100% of CMS OPPS Rate,78.4,14% of Total Billed Charges,78.4,420,280.00
Outpatient Medical Services,RADIOLOGY,93880,Study of vessels on both sides of the head and neck,921,1011.29,758.47,75% of Total billed charges,758.47,75% of Total billed charges,219.54,100% of CMS OPPS Rate,125.11,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,125.11,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,141.58,14% of Total Billed Charges,125.11,1083.29,505.65
Outpatient Medical Services,RADIOLOGY,93926,US Lower Ext Arterial Lt Complete,921,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,84.58,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,84.58,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,93970,Complete bilateral study of the extremities,921,1011.29,758.47,75% of Total billed charges,758.47,75% of Total billed charges,219.54,100% of CMS OPPS Rate,122.65,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,122.65,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,141.58,14% of Total Billed Charges,122.65,1083.29,505.65
Outpatient Medical Services,RADIOLOGY,93970,Complete bilateral study of the extremities,921,1011.29,758.47,75% of Total billed charges,758.47,75% of Total billed charges,219.54,100% of CMS OPPS Rate,122.65,100% of Medicaid Fee Schedule,362.24,165% of CMS OPPS Rate,227.53,111% CMS OPPS Rate,630.61,307.63% of CMS OPPS RATE,864.84,421.89% of CMS OPPS Rate,1083.29,258.46% of CMS OPPS Rate,122.65,100% of WV Medicaid Fee Schedule,219.54,100% of CMS OPPS Rate,227.53,111% of CMS OPPS Rate ,141.58,14% of Total Billed Charges,122.65,1083.29,505.65
Outpatient Medical Services,RADIOLOGY,93971,One sided or limited bilateral study,921,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,93971,One sided or limited bilateral study,921,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,93971,One sided or limited bilateral study,921,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,93971,One sided or limited bilateral study,921,481.13,360.85,75% of Total billed charges,360.85,75% of Total billed charges,100.48,100% of CMS OPPS Rate,77.67,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,77.67,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,67.36,14% of Total Billed Charges,67.36,495.81,240.57
Outpatient Medical Services,RADIOLOGY,93976,US Duplex Abd Pelvic Retro Limited,921,452.43,339.32,75% of Total billed charges,339.32,75% of Total billed charges,100.48,100% of CMS OPPS Rate,94.82,100% of Medicaid Fee Schedule,165.79,165% of CMS OPPS Rate,104.13,111% CMS OPPS Rate,288.62,307.63% of CMS OPPS RATE,395.82,421.89% of CMS OPPS Rate,495.81,258.46% of CMS OPPS Rate,94.82,100% of WV Medicaid Fee Schedule,100.48,100% of CMS OPPS Rate,104.13,111% of CMS OPPS Rate ,63.34,14% of Total Billed Charges,63.34,495.81,226.22
Outpatient Medical Services,AMBULATORY SURGERY,19120,REMOVAL OF BREAST LESION,360,13814.86,10361.15,75% of Total billed charges,10361.15,75% of Total billed charges,3232.09,100% of CMS OPPS Rate,950.21,102% of Medicaid Fee Schedule,5332.96,165% of CMS OPPS Rate,3349.79,111% CMS OPPS Rate,9283.77,307.63% of CMS OPPS RATE,12731.95,421.89% of CMS OPPS Rate,15948.06,258.46% of CMS OPPS Rate,931.58,100% of WV Medicaid Fee Schedule,3232.09,100% of CMS OPPS Rate,3349.79,111% of CMS OPPS Rate ,1934.08,14% of Total Billed Charges,931.58,15948.06,6907.43
Outpatient Medical Services,AMBULATORY SURGERY,45380,Biopsy of large bowel using an endoscope,360,4540.05,3405.04,75% of Total billed charges,3405.04,75% of Total billed charges,1018.11,100% of CMS OPPS Rate,423.26,102% of Medicaid Fee Schedule,1679.88,165% of CMS OPPS Rate,1055.19,111% CMS OPPS Rate,2924.39,307.63% of CMS OPPS RATE,4010.57,421.89% of CMS OPPS Rate,5023.64,258.46% of CMS OPPS Rate,414.96,100% of WV Medicaid Fee Schedule,1018.11,100% of CMS OPPS Rate,1055.19,111% of CMS OPPS Rate ,635.61,14% of Total Billed Charges,414.96,5023.64,2270.03
Outpatient Medical Services,AMBULATORY SURGERY,55700,Biopsy of prostate gland,360,7835.53,5876.65,75% of Total billed charges,5876.65,75% of Total billed charges,1743.88,100% of CMS OPPS Rate,643.69,102% of Medicaid Fee Schedule,2877.42,165% of CMS OPPS Rate,1807.39,111% CMS OPPS Rate,5009.09,307.63% of CMS OPPS RATE,6869.58,421.89% of CMS OPPS Rate,8604.84,258.46% of CMS OPPS Rate,631.07,100% of WV Medicaid Fee Schedule,1743.88,100% of CMS OPPS Rate,1807.39,111% of CMS OPPS Rate ,1096.97,14% of Total Billed Charges,631.07,8604.84,3917.77
Outpatient Medical Services,AMBULATORY SURGERY,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,360,2638.85,1979.14,75% of Total billed charges,1979.14,75% of Total billed charges,801.18,100% of CMS OPPS Rate,259.2,102% of Medicaid Fee Schedule,1321.95,165% of CMS OPPS Rate,830.35,111% CMS OPPS Rate,2301.31,307.63% of CMS OPPS RATE,3156.06,421.89% of CMS OPPS Rate,3953.29,258.46% of CMS OPPS Rate,254.12,100% of WV Medicaid Fee Schedule,801.18,100% of CMS OPPS Rate,830.35,111% of CMS OPPS Rate ,369.44,14% of Total Billed Charges,254.12,3953.29,1319.43
Outpatient Medical Services,AMBULATORY SURGERY,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,3420.95,2565.71,75% of Total billed charges,2565.71,75% of Total billed charges,801.18,100% of CMS OPPS Rate,336.02,102% of Medicaid Fee Schedule,1321.95,165% of CMS OPPS Rate,830.35,111% CMS OPPS Rate,2301.31,307.63% of CMS OPPS RATE,3156.06,421.89% of CMS OPPS Rate,3953.29,258.46% of CMS OPPS Rate,329.43,100% of WV Medicaid Fee Schedule,801.18,100% of CMS OPPS Rate,830.35,111% of CMS OPPS Rate ,478.93,14% of Total Billed Charges,329.43,3953.29,1710.48
Outpatient Medical Services,AMBULATORY SURGERY,99152,99152-Moderate Sedation Initial,481,847.84,635.88,75% of Total billed charges,635.88,75% of Total billed charges,271.31,32% of Total Billed Charges,9.09,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,9.09,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,118.7,14% of Total Billed Charges,9.09,635.88,423.92
Outpatient Medical Services,AMBULATORY SURGERY,99153,99153-Moderate Sedation additional 15 min,481,424.48,318.36,75% of Total billed charges,318.36,75% of Total billed charges,135.83,32% of Total Billed Charges,6.88,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,6.88,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,59.43,14% of Total Billed Charges,6.88,318.36,212.24
Outpatient Medical Services,AMBULATORY SURGERY,G0378,Observation,762,90.72,68.04,75% of Total billed charges,68.04,75% of Total billed charges,29.03,32% of Total Billed Charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,12.7,14% of Total Billed Charges,12.7,68.04,45.36
Outpatient Medical Services,AMBULATORY SURGERY,94640,INHALER TREATMENT/TEACHING,410,781.14,585.86,75% of Total billed charges,585.86,75% of Total billed charges,180.04,100% of CMS OPPS Rate,6.88,100% of Medicaid Fee Schedule,297.06,165% of CMS OPPS Rate,186.59,111% CMS OPPS Rate,517.14,307.63% of CMS OPPS RATE,709.22,421.89% of CMS OPPS Rate,888.37,258.46% of CMS OPPS Rate,6.88,100% of WV Medicaid Fee Schedule,180.04,100% of CMS OPPS Rate,186.59,111% of CMS OPPS Rate ,109.36,14% of Total Billed Charges,6.88,888.37,390.57
Outpatient Medical Services,AMBULATORY SURGERY,94640,NEBULIZER,410,781.14,585.86,75% of Total billed charges,585.86,75% of Total billed charges,180.04,100% of CMS OPPS Rate,6.88,100% of Medicaid Fee Schedule,297.06,165% of CMS OPPS Rate,186.59,111% CMS OPPS Rate,517.14,307.63% of CMS OPPS RATE,709.22,421.89% of CMS OPPS Rate,888.37,258.46% of CMS OPPS Rate,6.88,100% of WV Medicaid Fee Schedule,180.04,100% of CMS OPPS Rate,186.59,111% of CMS OPPS Rate ,109.36,14% of Total Billed Charges,6.88,888.37,390.57
Outpatient Medical Services,AMBULATORY SURGERY,94760,Pulse Oximetry Determination,460,176.96,132.72,75% of Total billed charges,132.72,75% of Total billed charges,56.63,32% of Total Billed Charges,1.47,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,1.47,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,24.77,14% of Total Billed Charges,1.47,132.72,88.48
Outpatient Medical Services,THERAPY,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",430,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,27.91,100% of CMS OPPS Rate,19.91,100% of Medicaid Fee Schedule,46.05,165% of CMS OPPS Rate,27.23,100% of CMS OPPS RATE ,98.95,354.54% OF CMS OPPS RATE,119.65,428.7% of CMS OPPS Rate,125.82,450.81% of CMS OPPS Rate,19.91,100% of WV Medicaid Fee Schedule,27.91,100% of CMS OPPS Rate,27.23,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,10.98,125.82,39.20
Outpatient Medical Services,THERAPY,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",420,91.84,68.88,75% of Total billed charges,68.88,75% of Total billed charges,27.91,100% of CMS OPPS Rate,19.91,100% of Medicaid Fee Schedule,46.05,165% of CMS OPPS Rate,27.23,100% of CMS OPPS RATE ,98.95,354.54% OF CMS OPPS RATE,119.65,428.7% of CMS OPPS Rate,125.82,450.81% of CMS OPPS Rate,19.91,100% of WV Medicaid Fee Schedule,27.91,100% of CMS OPPS Rate,27.23,100% of CMS OPPS Rate,12.86,14% of Total Billed Charges,12.86,125.82,45.92
Outpatient Medical Services,THERAPY,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",420,78.4,58.8,75% of Total billed charges,58.8,75% of Total billed charges,27.91,100% of CMS OPPS Rate,19.91,100% of Medicaid Fee Schedule,46.05,165% of CMS OPPS Rate,27.23,100% of CMS OPPS RATE ,98.95,354.54% OF CMS OPPS RATE,119.65,428.7% of CMS OPPS Rate,125.82,450.81% of CMS OPPS Rate,19.91,100% of WV Medicaid Fee Schedule,27.91,100% of CMS OPPS Rate,27.23,100% of CMS OPPS Rate,10.98,14% of Total Billed Charges,10.98,125.82,39.20
Outpatient Medical Services,THERAPY,97116,A type of physical therapy,420,69.44,52.08,75% of Total billed charges,52.08,75% of Total billed charges,27.91,100% of CMS OPPS Rate,19.91,100% of Medicaid Fee Schedule,46.05,165% of CMS OPPS Rate,27.23,100% of CMS OPPS RATE ,98.95,354.54% OF CMS OPPS RATE,119.65,428.7% of CMS OPPS Rate,125.82,450.81% of CMS OPPS Rate,19.91,100% of WV Medicaid Fee Schedule,27.91,100% of CMS OPPS Rate,27.23,100% of CMS OPPS Rate,9.72,14% of Total Billed Charges,9.72,125.82,34.72
Outpatient Medical Services,THERAPY,97161,Eval Initial Low Complexity,424,161.28,120.96,75% of Total billed charges,120.96,75% of Total billed charges,95.28,100% of CMS OPPS Rate,68.33,100% of Medicaid Fee Schedule,157.21,165% of CMS OPPS Rate,92.96,100% of CMS OPPS RATE ,337.81,354.54% OF CMS OPPS RATE,408.47,428.7% of CMS OPPS Rate,429.53,450.81% of CMS OPPS Rate,68.33,100% of WV Medicaid Fee Schedule,95.28,100% of CMS OPPS Rate,92.96,100% of CMS OPPS Rate,22.58,14% of Total Billed Charges,22.58,429.53,80.64
Outpatient Medical Services,SLEEP STUDIES,95810,Sleep monitoring of patient (6 years or older) in sleep lab,740,3823.27,2867.45,75% of Total billed charges,2867.45,75% of Total billed charges,878.46,100% of CMS OPPS Rate,389.35,100% of Medicaid Fee Schedule,1449.46,165% of CMS OPPS Rate,910.46,111% CMS OPPS Rate,2523.29,307.63% of CMS OPPS RATE,3460.48,421.89% of CMS OPPS Rate,4334.6,258.46% of CMS OPPS Rate,389.35,100% of WV Medicaid Fee Schedule,878.46,100% of CMS OPPS Rate,910.46,111% of CMS OPPS Rate ,535.26,14% of Total Billed Charges,389.35,4334.6,1911.64
Outpatient Medical Services,EMERGENCY ROOM,69209,Remove Impacted Ear Wax Uni,450,231.34,173.51,75% of Total billed charges,173.51,75% of Total billed charges,54.04,100% of CMS OPPS Rate,N/A,Not Applicable,89.16,165% of CMS OPPS Rate,56,111% CMS OPPS Rate,155.22,307.63% of CMS OPPS RATE,212.87,421.89% of CMS OPPS Rate,266.65,258.46% of CMS OPPS Rate,N/A,Not Applicable,54.04,100% of CMS OPPS Rate,56,111% of CMS OPPS Rate ,32.39,14% of Total Billed Charges,32.39,266.65,115.67
Outpatient Medical Services,EMERGENCY ROOM,90471,Immunization administration by a medical assistant or nurse,450,276.14,207.11,75% of Total billed charges,207.11,75% of Total billed charges,63.43,100% of CMS OPPS Rate,N/A,Not Applicable,104.66,165% of CMS OPPS Rate,65.74,111% CMS OPPS Rate,182.2,307.63% of CMS OPPS RATE,249.87,421.89% of CMS OPPS Rate,312.99,258.46% of CMS OPPS Rate,N/A,Not Applicable,63.43,100% of CMS OPPS Rate,65.74,111% of CMS OPPS Rate ,38.66,14% of Total Billed Charges,38.66,312.99,138.07
Outpatient Medical Services,EMERGENCY ROOM,92950,Cardiopulmonary Resuscitation,450,1099.82,824.87,75% of Total billed charges,824.87,75% of Total billed charges,263.29,100% of CMS OPPS Rate,131.01,100% of Medicaid Fee Schedule,434.44,165% of CMS OPPS Rate,272.88,111% CMS OPPS Rate,756.29,307.63% of CMS OPPS RATE,1037.2,421.89% of CMS OPPS Rate,1299.2,258.46% of CMS OPPS Rate,131.01,100% of WV Medicaid Fee Schedule,263.29,100% of CMS OPPS Rate,272.88,111% of CMS OPPS Rate ,153.97,14% of Total Billed Charges,131.01,1299.2,549.91
Outpatient Medical Services,EMERGENCY ROOM,96360,ED Hydration Initial,450,899.65,674.74,75% of Total billed charges,674.74,75% of Total billed charges,194.2,100% of CMS OPPS Rate,21.88,100% of Medicaid Fee Schedule,320.44,165% of CMS OPPS Rate,201.28,111% CMS OPPS Rate,557.84,307.63% of CMS OPPS RATE,765.02,421.89% of CMS OPPS Rate,958.27,258.46% of CMS OPPS Rate,21.88,100% of WV Medicaid Fee Schedule,194.2,100% of CMS OPPS Rate,201.28,111% of CMS OPPS Rate ,125.95,14% of Total Billed Charges,21.88,958.27,449.83
Outpatient Medical Services,EMERGENCY ROOM,96361,ED Hydration Add'l Hours,450,180,135,75% of Total billed charges,135,75% of Total billed charges,39.83,100% of CMS OPPS Rate,8.36,100% of Medicaid Fee Schedule,65.72,165% of CMS OPPS Rate,41.28,111% CMS OPPS Rate,114.41,307.63% of CMS OPPS RATE,156.91,421.89% of CMS OPPS Rate,196.54,258.46% of CMS OPPS Rate,8.36,100% of WV Medicaid Fee Schedule,39.83,100% of CMS OPPS Rate,41.28,111% of CMS OPPS Rate ,25.2,14% of Total Billed Charges,8.36,196.54,90.00
Outpatient Medical Services,EMERGENCY ROOM,96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",450,899.65,674.74,75% of Total billed charges,674.74,75% of Total billed charges,194.2,100% of CMS OPPS Rate,43.26,100% of Medicaid Fee Schedule,320.44,165% of CMS OPPS Rate,201.28,111% CMS OPPS Rate,557.84,307.63% of CMS OPPS RATE,765.02,421.89% of CMS OPPS Rate,958.27,258.46% of CMS OPPS Rate,43.26,100% of WV Medicaid Fee Schedule,194.2,100% of CMS OPPS Rate,201.28,111% of CMS OPPS Rate ,125.95,14% of Total Billed Charges,43.26,958.27,449.83
Outpatient Medical Services,EMERGENCY ROOM,96366,"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additional infusions",450,166.29,124.72,75% of Total billed charges,124.72,75% of Total billed charges,39.83,100% of CMS OPPS Rate,13.76,100% of Medicaid Fee Schedule,65.72,165% of CMS OPPS Rate,41.28,111% CMS OPPS Rate,114.41,307.63% of CMS OPPS RATE,156.91,421.89% of CMS OPPS Rate,196.54,258.46% of CMS OPPS Rate,13.76,100% of WV Medicaid Fee Schedule,39.83,100% of CMS OPPS Rate,41.28,111% of CMS OPPS Rate ,23.28,14% of Total Billed Charges,13.76,196.54,83.15
Outpatient Medical Services,EMERGENCY ROOM,96367,ED Sequential Drug Infusion,450,276.14,207.11,75% of Total billed charges,207.11,75% of Total billed charges,63.42,100% of CMS OPPS Rate,19.42,100% of Medicaid Fee Schedule,104.65,165% of CMS OPPS Rate,65.73,111% CMS OPPS Rate,182.19,307.63% of CMS OPPS RATE,249.86,421.89% of CMS OPPS Rate,312.99,258.46% of CMS OPPS Rate,19.42,100% of WV Medicaid Fee Schedule,63.42,100% of CMS OPPS Rate,65.73,111% of CMS OPPS Rate ,38.66,14% of Total Billed Charges,19.42,312.99,138.07
Outpatient Medical Services,EMERGENCY ROOM,96368,ED Concurrent Non-Chemo Infusion,450,452.48,339.36,75% of Total billed charges,339.36,75% of Total billed charges,144.79,32% of Total Billed Charges,13.27,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,13.27,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,63.35,14% of Total Billed Charges,13.27,339.36,226.24
Outpatient Medical Services,EMERGENCY ROOM,96372,ED IM/SQ,450,276.14,207.11,75% of Total billed charges,207.11,75% of Total billed charges,63.43,100% of CMS OPPS Rate,9.59,100% of Medicaid Fee Schedule,104.66,165% of CMS OPPS Rate,65.74,111% CMS OPPS Rate,182.2,307.63% of CMS OPPS RATE,249.87,421.89% of CMS OPPS Rate,312.99,258.46% of CMS OPPS Rate,9.59,100% of WV Medicaid Fee Schedule,63.43,100% of CMS OPPS Rate,65.74,111% of CMS OPPS Rate ,38.66,14% of Total Billed Charges,9.59,312.99,138.07
Outpatient Medical Services,EMERGENCY ROOM,96374,"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",450,899.65,674.74,75% of Total billed charges,674.74,75% of Total billed charges,194.2,100% of CMS OPPS Rate,25.07,100% of Medicaid Fee Schedule,320.44,165% of CMS OPPS Rate,201.28,111% CMS OPPS Rate,557.84,307.63% of CMS OPPS RATE,765.02,421.89% of CMS OPPS Rate,958.27,258.46% of CMS OPPS Rate,25.07,100% of WV Medicaid Fee Schedule,194.2,100% of CMS OPPS Rate,201.28,111% of CMS OPPS Rate ,125.95,14% of Total Billed Charges,25.07,958.27,449.83
Outpatient Medical Services,EMERGENCY ROOM,96375,"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",450,166.29,124.72,75% of Total billed charges,124.72,75% of Total billed charges,39.83,100% of CMS OPPS Rate,10.32,100% of Medicaid Fee Schedule,65.72,165% of CMS OPPS Rate,41.28,111% CMS OPPS Rate,114.41,307.63% of CMS OPPS RATE,156.91,421.89% of CMS OPPS Rate,196.54,258.46% of CMS OPPS Rate,10.32,100% of WV Medicaid Fee Schedule,39.83,100% of CMS OPPS Rate,41.28,111% of CMS OPPS Rate ,23.28,14% of Total Billed Charges,10.32,196.54,83.15
Outpatient Medical Services,EMERGENCY ROOM,96376,"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",450,141.12,105.84,75% of Total billed charges,105.84,75% of Total billed charges,45.16,32% of Total Billed Charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,19.76,14% of Total Billed Charges,19.76,105.84,70.56
Outpatient Medical Services,EMERGENCY ROOM,99152,Moderate Sedation Initial 15 Minute,450,847.84,635.88,75% of Total billed charges,635.88,75% of Total billed charges,271.31,32% of Total Billed Charges,9.09,100% of Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,9.09,100% of WV Medicaid Fee Schedule,N/A,Not Applicable,N/A,Not Applicable,118.7,14% of Total Billed Charges,9.09,635.88,423.92
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency Room Brief,450,301.45,226.09,75% of Total billed charges,226.09,75% of Total billed charges,70.58,100% of CMS OPPS Rate,35.89,Case Rate,116.47,165% of CMS OPPS Rate,73.16,111% CMS OPPS Rate,202.77,307.63% of CMS OPPS RATE,278.08,421.89% of CMS OPPS Rate,348.34,258.46% of CMS OPPS Rate,35.49,Case Rate,70.58,100% of CMS OPPS Rate,73.16,111% of CMS OPPS Rate ,42.2,14% of Total Billed Charges,35.49,348.34,150.73
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency Room Brief W Mod,450,301.45,226.09,75% of Total billed charges,226.09,75% of Total billed charges,70.58,100% of CMS OPPS Rate,35.89,Case Rate,116.47,165% of CMS OPPS Rate,73.16,111% CMS OPPS Rate,202.77,307.63% of CMS OPPS RATE,278.08,421.89% of CMS OPPS Rate,348.34,258.46% of CMS OPPS Rate,35.49,Case Rate,70.58,100% of CMS OPPS Rate,73.16,111% of CMS OPPS Rate ,42.2,14% of Total Billed Charges,35.49,348.34,150.73
Outpatient Medical Services,EMERGENCY ROOM,99282,Emer Room Routine W Mod,450,579.46,434.6,75% of Total billed charges,434.6,75% of Total billed charges,131.32,100% of CMS OPPS Rate,81.23,Case Rate,216.68,165% of CMS OPPS Rate,136.1,111% CMS OPPS Rate,377.22,307.63% of CMS OPPS RATE,517.33,421.89% of CMS OPPS Rate,648.02,258.46% of CMS OPPS Rate,80.23,Case Rate,131.32,100% of CMS OPPS Rate,136.1,111% of CMS OPPS Rate ,81.12,14% of Total Billed Charges,80.23,648.02,289.73
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY DEPARTMENT VISIT LOW MODER SEVERITY,450,579.46,434.6,75% of Total billed charges,434.6,75% of Total billed charges,131.32,100% of CMS OPPS Rate,81.23,Case Rate,216.68,165% of CMS OPPS Rate,136.1,111% CMS OPPS Rate,377.22,307.63% of CMS OPPS RATE,517.33,421.89% of CMS OPPS Rate,648.02,258.46% of CMS OPPS Rate,80.23,Case Rate,131.32,100% of CMS OPPS Rate,136.1,111% of CMS OPPS Rate ,81.12,14% of Total Billed Charges,80.23,648.02,289.73
Outpatient Medical Services,EMERGENCY ROOM,99283,"Emergency department visit, moderately severe problem",450,1017.09,762.82,75% of Total billed charges,762.82,75% of Total billed charges,230.36,100% of CMS OPPS Rate,151.33,Case Rate,380.09,165% of CMS OPPS Rate,238.75,111% CMS OPPS Rate,661.69,307.63% of CMS OPPS RATE,907.46,421.89% of CMS OPPS Rate,1136.69,258.46% of CMS OPPS Rate,149.37,Case Rate,230.36,100% of CMS OPPS Rate,238.75,111% of CMS OPPS Rate ,142.39,14% of Total Billed Charges,142.39,1136.69,508.55
Outpatient Medical Services,EMERGENCY ROOM,99283,"Emergency department visit, moderately severe problem",450,1017.09,762.82,75% of Total billed charges,762.82,75% of Total billed charges,230.36,100% of CMS OPPS Rate,151.33,Case Rate,380.09,165% of CMS OPPS Rate,238.75,111% CMS OPPS Rate,661.69,307.63% of CMS OPPS RATE,907.46,421.89% of CMS OPPS Rate,1136.69,258.46% of CMS OPPS Rate,149.37,Case Rate,230.36,100% of CMS OPPS Rate,238.75,111% of CMS OPPS Rate ,142.39,14% of Total Billed Charges,142.39,1136.69,508.55
Outpatient Medical Services,EMERGENCY ROOM,99283,"Emergency department visit, moderately severe problem",450,1017.09,762.82,75% of Total billed charges,762.82,75% of Total billed charges,230.36,100% of CMS OPPS Rate,151.33,Case Rate,380.09,165% of CMS OPPS Rate,238.75,111% CMS OPPS Rate,661.69,307.63% of CMS OPPS RATE,907.46,421.89% of CMS OPPS Rate,1136.69,258.46% of CMS OPPS Rate,149.37,Case Rate,230.36,100% of CMS OPPS Rate,238.75,111% of CMS OPPS Rate ,142.39,14% of Total Billed Charges,142.39,1136.69,508.55
Outpatient Medical Services,EMERGENCY ROOM,99284,"Emergency department visit, problem of high severity",450,1595.91,1196.93,75% of Total billed charges,1196.93,75% of Total billed charges,358.77,100% of CMS OPPS Rate,282.65,Case Rate,591.97,165% of CMS OPPS Rate,371.83,111% CMS OPPS Rate,1030.53,307.63% of CMS OPPS RATE,1413.29,421.89% of CMS OPPS Rate,1770.29,258.46% of CMS OPPS Rate,278.81,Case Rate,358.77,100% of CMS OPPS Rate,371.83,111% of CMS OPPS Rate ,223.43,14% of Total Billed Charges,223.43,1770.29,797.96
Outpatient Medical Services,EMERGENCY ROOM,99284,"Emergency department visit, problem of high severity",450,1595.91,1196.93,75% of Total billed charges,1196.93,75% of Total billed charges,358.77,100% of CMS OPPS Rate,282.65,Case Rate,591.97,165% of CMS OPPS Rate,371.83,111% CMS OPPS Rate,1030.53,307.63% of CMS OPPS RATE,1413.29,421.89% of CMS OPPS Rate,1770.29,258.46% of CMS OPPS Rate,278.81,Case Rate,358.77,100% of CMS OPPS Rate,371.83,111% of CMS OPPS Rate ,223.43,14% of Total Billed Charges,223.43,1770.29,797.96
Outpatient Medical Services,EMERGENCY ROOM,99285,"Emergency department visit, problem with significant threat to life or function",450,2288.53,1716.4,75% of Total billed charges,1716.4,75% of Total billed charges,515.3,100% of CMS OPPS Rate,718.25,Case Rate,850.26,165% of CMS OPPS Rate,534.07,111% CMS OPPS Rate,1480.16,307.63% of CMS OPPS RATE,2029.93,421.89% of CMS OPPS Rate,2542.69,258.46% of CMS OPPS Rate,706.64,Case Rate,515.3,100% of CMS OPPS Rate,534.07,111% of CMS OPPS Rate ,320.39,14% of Total Billed Charges,320.39,2542.69,1144.27
Outpatient Medical Services,EMERGENCY ROOM,99285,"Emergency department visit, problem with significant threat to life or function",450,2288.53,1716.4,75% of Total billed charges,1716.4,75% of Total billed charges,515.3,100% of CMS OPPS Rate,718.25,Case Rate,850.26,165% of CMS OPPS Rate,534.07,111% CMS OPPS Rate,1480.16,307.63% of CMS OPPS RATE,2029.93,421.89% of CMS OPPS Rate,2542.69,258.46% of CMS OPPS Rate,706.64,Case Rate,515.3,100% of CMS OPPS Rate,534.07,111% of CMS OPPS Rate ,320.39,14% of Total Billed Charges,320.39,2542.69,1144.27
Outpatient Medical Services,EMERGENCY ROOM,99291,Emer Room Critical,450,3262.59,2446.94,75% of Total billed charges,2446.94,75% of Total billed charges,721.77,100% of CMS OPPS Rate,N/A,Not Applicable,1190.93,165% of CMS OPPS Rate,748.06,111% CMS OPPS Rate,2073.21,307.63% of CMS OPPS RATE,2843.26,421.89% of CMS OPPS Rate,3561.47,258.46% of CMS OPPS Rate,N/A,Not Applicable,721.77,100% of CMS OPPS Rate,748.06,111% of CMS OPPS Rate ,456.76,14% of Total Billed Charges,456.76,3561.47,1631.30
Outpatient Medical Services,EMERGENCY ROOM,99291,Emer Room Critical Care,450,3262.59,2446.94,75% of Total billed charges,2446.94,75% of Total billed charges,721.77,100% of CMS OPPS Rate,N/A,Not Applicable,1190.93,165% of CMS OPPS Rate,748.06,111% CMS OPPS Rate,2073.21,307.63% of CMS OPPS RATE,2843.26,421.89% of CMS OPPS Rate,3561.47,258.46% of CMS OPPS Rate,N/A,Not Applicable,721.77,100% of CMS OPPS Rate,748.06,111% of CMS OPPS Rate ,456.76,14% of Total Billed Charges,456.76,3561.47,1631.30
Outpatient Medical Services,EMERGENCY ROOM,99292,Emer Room Critical Care Add 30Min,450,384.16,288.12,75% of Total billed charges,288.12,75% of Total billed charges,122.93,32% of Total Billed Charges,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,N/A,Not Applicable,53.78,14% of Total Billed Charges,53.78,288.12,192.08
Outpatient Medical Services,CARDIAC,93005,EKG-INPATIENT,730,248.45,186.34,75% of Total billed charges,186.34,75% of Total billed charges,54.04,100% of CMS OPPS Rate,3.93,100% of Medicaid Fee Schedule,89.16,165% of CMS OPPS Rate,56,111% CMS OPPS Rate,155.22,307.63% of CMS OPPS RATE,212.87,421.89% of CMS OPPS Rate,266.65,258.46% of CMS OPPS Rate,3.93,100% of WV Medicaid Fee Schedule,54.04,100% of CMS OPPS Rate,56,111% of CMS OPPS Rate ,34.78,14% of Total Billed Charges,3.93,266.65,124.23
Outpatient Medical Services,CARDIAC,93005,Electrocardiogram-Outpatient,730,248.45,186.34,75% of Total billed charges,186.34,75% of Total billed charges,54.04,100% of CMS OPPS Rate,3.93,100% of Medicaid Fee Schedule,89.16,165% of CMS OPPS Rate,56,111% CMS OPPS Rate,155.22,307.63% of CMS OPPS RATE,212.87,421.89% of CMS OPPS Rate,266.65,258.46% of CMS OPPS Rate,3.93,100% of WV Medicaid Fee Schedule,54.04,100% of CMS OPPS Rate,56,111% of CMS OPPS Rate ,34.78,14% of Total Billed Charges,3.93,266.65,124.23
Outpatient Medical Services,CARDIAC,93270,93270- Ext pt/auto ECG/30 day/MD interp,731,167.85,125.89,75% of Total billed charges,125.89,75% of Total billed charges,32.9,100% of CMS OPPS Rate,5.41,100% of Medicaid Fee Schedule,54.29,165% of CMS OPPS Rate,34.1,111% CMS OPPS Rate,94.51,307.63% of CMS OPPS RATE,129.62,421.89% of CMS OPPS Rate,162.36,258.46% of CMS OPPS Rate,5.41,100% of WV Medicaid Fee Schedule,32.9,100% of CMS OPPS Rate,34.1,111% of CMS OPPS Rate ,23.5,14% of Total Billed Charges,5.41,162.36,83.93
Outpatient Medical Services,CARDIAC,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",483,2118.14,1588.61,75% of Total billed charges,1588.61,75% of Total billed charges,473.01,100% of CMS OPPS Rate,130.52,100% of Medicaid Fee Schedule,780.48,165% of CMS OPPS Rate,490.24,111% CMS OPPS Rate,1358.69,307.63% of CMS OPPS RATE,1863.34,421.89% of CMS OPPS Rate,2334.03,258.46% of CMS OPPS Rate,130.52,100% of WV Medicaid Fee Schedule,473.01,100% of CMS OPPS Rate,490.24,111% of CMS OPPS Rate ,296.54,14% of Total Billed Charges,130.52,2334.03,1059.07
Outpatient Medical Services,CARDIAC,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",480,2118.14,1588.61,75% of Total billed charges,1588.61,75% of Total billed charges,473.01,100% of CMS OPPS Rate,130.52,100% of Medicaid Fee Schedule,780.48,165% of CMS OPPS Rate,490.24,111% CMS OPPS Rate,1358.69,307.63% of CMS OPPS RATE,1863.34,421.89% of CMS OPPS Rate,2334.03,258.46% of CMS OPPS Rate,130.52,100% of WV Medicaid Fee Schedule,473.01,100% of CMS OPPS Rate,490.24,111% of CMS OPPS Rate ,296.54,14% of Total Billed Charges,130.52,2334.03,1059.07
Outpatient Medical Services,CARDIAC,93452,Insertion of catheter into left heart for diagnosis,481,12050.42,9037.82,75% of Total billed charges,9037.82,75% of Total billed charges,2781.44,100% of CMS OPPS Rate,613.03,100% of Medicaid Fee Schedule,4589.37,165% of CMS OPPS Rate,2882.73,111% CMS OPPS Rate,7989.31,307.63% of CMS OPPS RATE,10956.7,421.89% of CMS OPPS Rate,13724.38,258.46% of CMS OPPS Rate,613.03,100% of WV Medicaid Fee Schedule,2781.44,100% of CMS OPPS Rate,2882.73,111% of CMS OPPS Rate ,1687.06,14% of Total Billed Charges,613.03,13724.38,6025.21
Outpatient Medical Services,CARDIAC,93458,"93458-LEFT HEART CATH, LV, COR",481,12686.59,9514.94,75% of Total billed charges,9514.94,75% of Total billed charges,2781.44,100% of CMS OPPS Rate,706.18,100% of Medicaid Fee Schedule,4589.37,165% of CMS OPPS Rate,2882.73,111% CMS OPPS Rate,7989.31,307.63% of CMS OPPS RATE,10956.7,421.89% of CMS OPPS Rate,13724.38,258.46% of CMS OPPS Rate,706.18,100% of WV Medicaid Fee Schedule,2781.44,100% of CMS OPPS Rate,2882.73,111% of CMS OPPS Rate ,1776.12,14% of Total Billed Charges,706.18,13724.38,6343.30
Outpatient Medical Services,CARDIAC,94660,BIPAP,410,781.14,585.86,75% of Total billed charges,585.86,75% of Total billed charges,180.04,100% of CMS OPPS Rate,26.55,100% of Medicaid Fee Schedule,297.06,165% of CMS OPPS Rate,186.59,111% CMS OPPS Rate,517.14,307.63% of CMS OPPS RATE,709.22,421.89% of CMS OPPS Rate,888.37,258.46% of CMS OPPS Rate,26.55,100% of WV Medicaid Fee Schedule,180.04,100% of CMS OPPS Rate,186.59,111% of CMS OPPS Rate ,109.36,14% of Total Billed Charges,26.55,888.37,390.57
Outpatient Medical Services,CARDIAC,94664,FLUTTER VALVE,410,781.14,585.86,75% of Total billed charges,585.86,75% of Total billed charges,180.04,100% of CMS OPPS Rate,10.57,100% of Medicaid Fee Schedule,297.06,165% of CMS OPPS Rate,186.59,111% CMS OPPS Rate,517.14,307.63% of CMS OPPS RATE,709.22,421.89% of CMS OPPS Rate,888.37,258.46% of CMS OPPS Rate,10.57,100% of WV Medicaid Fee Schedule,180.04,100% of CMS OPPS Rate,186.59,111% of CMS OPPS Rate ,109.36,14% of Total Billed Charges,10.57,888.37,390.57
Outpatient Medical Services,CARDIAC,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",460,181.44,136.08,75% of Total billed charges,136.08,75% of Total billed charges,27.91,100% of CMS OPPS Rate,19.91,100% of Medicaid Fee Schedule,46.05,165% of CMS OPPS Rate,27.23,100% of CMS OPPS RATE ,98.95,354.54% OF CMS OPPS RATE,119.65,428.7% of CMS OPPS Rate,125.82,450.81% of CMS OPPS Rate,19.91,100% of WV Medicaid Fee Schedule,27.91,100% of CMS OPPS Rate,27.23,100% of CMS OPPS Rate,25.4,14% of Total Billed Charges,19.91,136.08,90.72
Outpatient Medical Services,CHEMO INJECTION,96365,"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",940,899.65,674.74,75% of Total billed charges,674.74,75% of Total billed charges,194.2,100% of CMS OPPS Rate,43.26,100% of Medicaid Fee Schedule,320.44,165% of CMS OPPS Rate,201.28,111% CMS OPPS Rate,557.84,307.63% of CMS OPPS RATE,765.02,421.89% of CMS OPPS Rate,958.27,258.46% of CMS OPPS Rate,43.26,100% of WV Medicaid Fee Schedule,194.2,100% of CMS OPPS Rate,201.28,111% of CMS OPPS Rate ,125.95,14% of Total Billed Charges,43.26,958.27,449.83
Outpatient Medical Services,CHEMO INJECTION,96374,"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",940,899.65,674.74,75% of Total billed charges,674.74,75% of Total billed charges,194.2,100% of CMS OPPS Rate,25.07,100% of Medicaid Fee Schedule,320.44,165% of CMS OPPS Rate,201.28,111% CMS OPPS Rate,557.84,307.63% of CMS OPPS RATE,765.02,421.89% of CMS OPPS Rate,958.27,258.46% of CMS OPPS Rate,25.07,100% of WV Medicaid Fee Schedule,194.2,100% of CMS OPPS Rate,201.28,111% of CMS OPPS Rate ,125.95,14% of Total Billed Charges,25.07,958.27,449.83
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable 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,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,Not applicable service not offered,N/A,N/A,N/A