hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|AR,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Dallas County Medical Center,2/28/2025,2.0.0,Dallas County Medical Center,"201 N Clifton ST, Fordyce, AR 71742",270029542,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AMBETTER PLAN,AMBETTER REIMBURSEMENT METHOD,AR TOTALCARE COMMERCIAL EXCHANGE PLAN,AR TOTALCARE COMMERCIAL EXCHANGE REIMBURSEMENT METHOD,AR TOTALCARE MEDICARE ADV PLAN,AR TOTALCARE MEDICARE ADV REIMBURSEMENT METHOD,BCBS AR FIRST SOURCE PPO PLAN,BCBS AR FIRST SOURCE PPO REIMBURSEMENT METHOD,BCBS HEALTH ADVANTAGE HMO PLAN,BCBS HEALTH ADVANTAGE HMO REIMBURSEMENT METHOD,BCBS HEALTH ADVANTAGE MEDICARE HMO PLAN,BCBS HEALTH ADVANTAGE MEDICARE HMO REIMBURSEMENT METHOD,BCBS TRUE BLUE PPO PLAN,BCBS TRUE BLUE PPO REIMBURSEMENT METHOD,CARESOURCE MARKETPLACE PLAN,CARESOURCE MARKETPLACE REIMBURSEMENT METHOD,CARESOURCE MEDICAID PLAN,CARESOURCE MEDICAID REIMBURSEMENT METHOD,CARESOURCE MEDICARE ADV PLAN,CARESOURCE MEDICARE ADV REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,UHC COMMERCIAL PLAN,UHC COMMERCIAL REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,VACCN PLAN,VACCN REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,RADIOLOGY,735.9,Tib/Fib 2 Views Right,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$163.35 ,90% of total billed charges,$163.35 ,90% of total billed charges,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$163.35 ,90% of total billed charges,$85.31 ,47% for INJ case rate,N/A,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,$163.35 ,$181.50 
Outpatient Medical Services,WOUND CLINIC,11042,Debridement Subq Tissue 1st 20 CM,361,$932.34 ,$547.75 ,58.75% of billed charges or 125% of CAH Medicare ,$547.75 ,58.75% of billed charges or 125% of CAH Medicare ,$451.35 ,48.41% of billed charges or 125% of CAH Medicare ,$349.44 ,100% of ASC tier grouper,$349.44 ,100% of ASC tier grouper,$438.20 ,47% of billed charges or 100% of CAH Medicare ,$349.44 ,100% of ASC tier grouper,$547.75 ,58.75% of billed charges or 125% of CAH Medicare ,$145.50 ,100% AR Medicaid ,$438.20 ,47% of billed charges or 100% of CAH Medicare ,$145.50 ,100% AR Medicaid ,$438.20 ,47% of billed charges or 100% of CAH Medicare ,$462.00 ,100% for ASC tier grouper,$438.20 ,47% of billed charges or 100% of CAH Medicare ,$438.20 ,47% of billed charges or 100% of CAH Medicare ,$145.50 ,$547.75 ,$932.34 
Outpatient Medical Services,WOUND CLINIC,11045,Debridement Ea Addl 20 CM,361,"$1,464.51 ",$860.40 ,58.75% of billed charges or 125% of CAH Medicare ,$860.40 ,58.75% of billed charges or 125% of CAH Medicare ,$708.97 ,48.41% of billed charges or 125% of CAH Medicare ,N/A,100% of ASC tier grouper,N/A,100% of ASC tier grouper,$688.32 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% of ASC tier grouper,$860.40 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$688.32 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$688.32 ,47% of billed charges or 100% of CAH Medicare ,$462.00 ,100% for ASC tier grouper,$688.32 ,47% of billed charges or 100% of CAH Medicare ,$688.32 ,47% of billed charges or 100% of CAH Medicare ,$462.00 ,$860.40 ,"$1,464.51 "
Outpatient Medical Services,WOUND CLINIC,16020,Dres/Debr Burn Small,361,"$1,132.20 ",$665.17 ,58.75% of billed charges or 125% of CAH Medicare ,$665.17 ,58.75% of billed charges or 125% of CAH Medicare ,$548.10 ,48.41% of billed charges or 125% of CAH Medicare ,$191.52 ,100% of ASC tier grouper,$191.52 ,100% of ASC tier grouper,$532.13 ,47% of billed charges or 100% of CAH Medicare ,$191.52 ,100% of ASC tier grouper,$665.17 ,58.75% of billed charges or 125% of CAH Medicare ,$102.00 ,100% AR Medicaid ,$532.13 ,47% of billed charges or 100% of CAH Medicare ,$102.00 ,100% AR Medicaid ,$532.13 ,47% of billed charges or 100% of CAH Medicare ,$462.00 ,100% for ASC tier grouper,$532.13 ,47% of billed charges or 100% of CAH Medicare ,$532.13 ,47% of billed charges or 100% of CAH Medicare ,$102.00 ,$665.17 ,"$1,132.20 "
Outpatient Medical Services,Respiratory Therapy,31720,Suctioning of Airway,410,$315.00 ,$185.06 ,58.75% of billed charges or 125% of CAH Medicare ,$185.06 ,58.75% of billed charges or 125% of CAH Medicare ,$152.49 ,48.41% of billed charges or 125% of CAH Medicare ,$201.60 ,100% of ASC tier grouper,$201.60 ,100% of ASC tier grouper,$148.05 ,47% of billed charges or 100% of CAH Medicare ,$201.60 ,100% of ASC tier grouper,$185.06 ,58.75% of billed charges or 125% of CAH Medicare ,$250.00 ,100% AR Medicaid ,$148.05 ,47% of billed charges or 100% of CAH Medicare ,$250.00 ,100% AR Medicaid ,$148.05 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$148.05 ,47% of billed charges or 100% of CAH Medicare ,$148.05 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,$250.00 ,$315.00 
Outpatient Medical Services,LAB,36415,Venipuncture,300,$19.95 ,$11.72 ,58.75% of billed charges or 125% of CAH Medicare ,$11.72 ,58.75% of billed charges or 125% of CAH Medicare ,$9.66 ,48.41% of billed charges or 125% of CAH Medicare ,N/A,100% of custom fee schedule,N/A,100% of custom fee schedule,$9.38 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% of custom fee schedule,$11.72 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$9.38 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$9.38 ,47% of billed charges or 100% of CAH Medicare ,$2.43 ,90% for custom fee schedule,$9.38 ,47% of billed charges or 100% of CAH Medicare ,$9.38 ,47% of billed charges or 100% of CAH Medicare ,$2.43 ,$11.72 ,$19.95 
Outpatient Medical Services,LAB,36430,Blood Administration,390,$564.00 ,$331.35 ,58.75% of billed charges or 125% of CAH Medicare ,$331.35 ,58.75% of billed charges or 125% of CAH Medicare ,$273.03 ,48.41% of billed charges or 125% of CAH Medicare ,$424.48 ,100% of ASC tier grouper,$424.48 ,100% of ASC tier grouper,$265.08 ,47% of billed charges or 100% of CAH Medicare ,$424.48 ,100% of ASC tier grouper,$331.35 ,58.75% of billed charges or 125% of CAH Medicare ,$30.31 ,100% AR Medicaid ,$265.08 ,47% of billed charges or 100% of CAH Medicare ,$30.31 ,100% AR Medicaid ,$265.08 ,47% of billed charges or 100% of CAH Medicare ,$350.00 ,100% of case rate,$265.08 ,47% of billed charges or 100% of CAH Medicare ,$265.08 ,47% of billed charges or 100% of CAH Medicare ,$30.31 ,$424.48 ,$564.00 
Outpatient Medical Services,Respiratory Therapy,36600,Arterial Puncture,410,$188.00 ,$110.45 ,58.75% of billed charges or 125% of CAH Medicare ,$110.45 ,58.75% of billed charges or 125% of CAH Medicare ,$91.01 ,48.41% of billed charges or 125% of CAH Medicare ,$119.84 ,100% of ASC tier grouper,$119.84 ,100% of ASC tier grouper,$88.36 ,47% of billed charges or 100% of CAH Medicare ,$119.84 ,100% of ASC tier grouper,$110.45 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$88.36 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$88.36 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$88.36 ,47% of billed charges or 100% of CAH Medicare ,$88.36 ,47% of billed charges or 100% of CAH Medicare ,$88.36 ,$119.84 ,$188.00 
Outpatient Medical Services,Physical Therapy,64550,TENS,420,$51.00 ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$24.69 ,48.41% of billed charges or 125% of CAH Medicare ,$45.90 ,90% of total billed charges,$45.90 ,90% of total billed charges,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$45.90 ,90% of total billed charges,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,$150.00 ,$51.00 
Outpatient Medical Services,RADIOLOGY,70150,Facial Bone 3 Views,320,$191.00 ,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$92.46 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$39.60 ,100% AR Medicaid ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$39.60 ,100% AR Medicaid ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$39.60 ,$284.64 ,$191.00 
Outpatient Medical Services,RADIOLOGY,70160,Nasal Bone-3,320,$191.00 ,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$92.46 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$112.21 ,58.75% of billed charges or 125% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$89.77 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,$211.49 ,$191.00 
Outpatient Medical Services,RADIOLOGY,70220,Sinus Paranasal 3 Views,320,$288.00 ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$139.42 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$49.50 ,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$49.50 ,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$49.50 ,$211.49 ,$288.00 
Outpatient Medical Services,RADIOLOGY,70250,Skull 3 Views,320,$254.60 ,$149.58 ,58.75% of billed charges or 125% of CAH Medicare ,$149.58 ,58.75% of billed charges or 125% of CAH Medicare ,$123.25 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$119.66 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$149.58 ,58.75% of billed charges or 125% of CAH Medicare ,$45.10 ,100% AR Medicaid ,$119.66 ,47% of billed charges or 100% of CAH Medicare ,$45.10 ,100% AR Medicaid ,$119.66 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$119.66 ,47% of billed charges or 100% of CAH Medicare ,$119.66 ,47% of billed charges or 100% of CAH Medicare ,$45.10 ,$284.64 ,$254.60 
Outpatient Medical Services,RADIOLOGY,70360,Neck (Soft Tissue),320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$20.90 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$20.90 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$20.90 ,$211.49 ,$181.50 
Outpatient Medical Services,CT,70450,"CT Scan, Head or Brain, without Contrast *",351,"$1,562.20 ",$917.79 ,58.75% of billed charges or 125% of CAH Medicare ,$917.79 ,58.75% of billed charges or 125% of CAH Medicare ,$756.26 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$734.23 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$917.79 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$734.23 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$734.23 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$734.23 ,47% of billed charges or 100% of CAH Medicare ,$734.23 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$917.79 ,"$1,562.20 "
Outpatient Medical Services,CT,70476,"CT Scan, Facial without Contrast",351,"$1,040.00 ",$611.00 ,58.75% of billed charges or 125% of CAH Medicare ,$611.00 ,58.75% of billed charges or 125% of CAH Medicare ,$503.46 ,48.41% of billed charges or 125% of CAH Medicare ,$936.00 ,90% of total billed charges,$936.00 ,90% of total billed charges,$488.80 ,47% of billed charges or 100% of CAH Medicare ,$936.00 ,90% of total billed charges,$611.00 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$488.80 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$488.80 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$488.80 ,47% of billed charges or 100% of CAH Medicare ,$488.80 ,47% of billed charges or 100% of CAH Medicare ,$488.80 ,$936.00 ,"$1,040.00 "
Outpatient Medical Services,RADIOLOGY,71045,Chest 1 View,320,$244.70 ,$143.76 ,58.75% of billed charges or 125% of CAH Medicare ,$143.76 ,58.75% of billed charges or 125% of CAH Medicare ,$118.46 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$115.01 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$143.76 ,58.75% of billed charges or 125% of CAH Medicare ,$13.65 ,100% AR Medicaid ,$115.01 ,47% of billed charges or 100% of CAH Medicare ,$13.65 ,100% AR Medicaid ,$115.01 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$115.01 ,47% of billed charges or 100% of CAH Medicare ,$115.01 ,47% of billed charges or 100% of CAH Medicare ,$13.65 ,$211.49 ,$244.70 
Outpatient Medical Services,RADIOLOGY,71046,Chest 2 Views,320,$235.55 ,$138.39 ,58.75% of billed charges or 125% of CAH Medicare ,$138.39 ,58.75% of billed charges or 125% of CAH Medicare ,$114.03 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$110.71 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$138.39 ,58.75% of billed charges or 125% of CAH Medicare ,$18.57 ,100% AR Medicaid ,$110.71 ,47% of billed charges or 100% of CAH Medicare ,$18.57 ,100% AR Medicaid ,$110.71 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$110.71 ,47% of billed charges or 100% of CAH Medicare ,$110.71 ,47% of billed charges or 100% of CAH Medicare ,$18.57 ,$211.49 ,$235.55 
Outpatient Medical Services,RADIOLOGY,71101,Ribs Unilat 3 views,320,$245.65 ,$144.32 ,58.75% of billed charges or 125% of CAH Medicare ,$144.32 ,58.75% of billed charges or 125% of CAH Medicare ,$118.92 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$115.46 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$144.32 ,58.75% of billed charges or 125% of CAH Medicare ,$46.20 ,100% AR Medicaid ,$115.46 ,47% of billed charges or 100% of CAH Medicare ,$46.20 ,100% AR Medicaid ,$115.46 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$115.46 ,47% of billed charges or 100% of CAH Medicare ,$115.46 ,47% of billed charges or 100% of CAH Medicare ,$46.20 ,$284.64 ,$245.65 
Outpatient Medical Services,CT,71250,"CT Scan, Chest without Contrast",352,"$1,861.00 ","$1,093.34 ",58.75% of billed charges or 125% of CAH Medicare ,"$1,093.34 ",58.75% of billed charges or 125% of CAH Medicare ,$900.91 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$874.67 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,"$1,093.34 ",58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$874.67 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$874.67 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$874.67 ,47% of billed charges or 100% of CAH Medicare ,$874.67 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,"$1,093.34 ","$1,861.00 "
Outpatient Medical Services,CT,71260,"CT Scan, Chest with Contrast",352,"$1,173.70 ",$689.55 ,58.75% of billed charges or 125% of CAH Medicare ,$689.55 ,58.75% of billed charges or 125% of CAH Medicare ,$568.19 ,48.41% of billed charges or 125% of CAH Medicare ,$174.94 ,100% of custom fee schedule,$174.94 ,100% of custom fee schedule,$551.64 ,47% of billed charges or 100% of CAH Medicare ,$174.94 ,100% of custom fee schedule,$689.55 ,58.75% of billed charges or 125% of CAH Medicare ,$75.19 ,100% AR Medicaid ,$551.64 ,47% of billed charges or 100% of CAH Medicare ,$75.19 ,100% AR Medicaid ,$551.64 ,47% of billed charges or 100% of CAH Medicare ,$467.02 ,160% for custom fee schedule,$551.64 ,47% of billed charges or 100% of CAH Medicare ,$551.64 ,47% of billed charges or 100% of CAH Medicare ,$75.19 ,$689.55 ,"$1,173.70 "
Outpatient Medical Services,RADIOLOGY,71340,Finger 2 Views,320,$167.20 ,$98.23 ,58.75% of billed charges or 125% of CAH Medicare ,$98.23 ,58.75% of billed charges or 125% of CAH Medicare ,$80.94 ,48.41% of billed charges or 125% of CAH Medicare ,$150.48 ,90% of total billed charges,$150.48 ,90% of total billed charges,$78.58 ,47% of billed charges or 100% of CAH Medicare ,$150.48 ,90% of total billed charges,$98.23 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$78.58 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$78.58 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$78.58 ,47% of billed charges or 100% of CAH Medicare ,$78.58 ,47% of billed charges or 100% of CAH Medicare ,$78.58 ,$150.48 ,$167.20 
Outpatient Medical Services,RADIOLOGY,72040,Spine Cervical 2-3 Views,320,$183.40 ,$107.75 ,58.75% of billed charges or 125% of CAH Medicare ,$107.75 ,58.75% of billed charges or 125% of CAH Medicare ,$88.78 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$86.20 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$107.75 ,58.75% of billed charges or 125% of CAH Medicare ,$46.00 ,100% AR Medicaid ,$86.20 ,47% of billed charges or 100% of CAH Medicare ,$46.00 ,100% AR Medicaid ,$86.20 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$86.20 ,47% of billed charges or 100% of CAH Medicare ,$86.20 ,47% of billed charges or 100% of CAH Medicare ,$46.00 ,$211.49 ,$183.40 
Outpatient Medical Services,RADIOLOGY,72070,Spine Thorasic 2 views,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$47.09 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$47.09 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$47.09 ,$284.64 ,$181.50 
Outpatient Medical Services,RADIOLOGY,72100,"Lower Back, 2-3 Views",320,$228.95 ,$134.51 ,58.75% of billed charges or 125% of CAH Medicare ,$134.51 ,58.75% of billed charges or 125% of CAH Medicare ,$110.83 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$107.61 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$134.51 ,58.75% of billed charges or 125% of CAH Medicare ,$46.20 ,100% AR Medicaid ,$107.61 ,47% of billed charges or 100% of CAH Medicare ,$46.20 ,100% AR Medicaid ,$107.61 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$107.61 ,47% of billed charges or 100% of CAH Medicare ,$107.61 ,47% of billed charges or 100% of CAH Medicare ,$46.20 ,$284.64 ,$228.95 
Outpatient Medical Services,RADIOLOGY,72110,"Lower Back, Minimum four views  *",320,$281.60 ,$165.44 ,58.75% of billed charges or 125% of CAH Medicare ,$165.44 ,58.75% of billed charges or 125% of CAH Medicare ,$136.32 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$132.35 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$165.44 ,58.75% of billed charges or 125% of CAH Medicare ,$66.00 ,100% AR Medicaid ,$132.35 ,47% of billed charges or 100% of CAH Medicare ,$66.00 ,100% AR Medicaid ,$132.35 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$132.35 ,47% of billed charges or 100% of CAH Medicare ,$132.35 ,47% of billed charges or 100% of CAH Medicare ,$66.00 ,$284.64 ,$281.60 
Outpatient Medical Services,CT,72125,"CT Scan, Cervical Spine Without Contrast",352,"$1,257.30 ",$738.66 ,58.75% of billed charges or 125% of CAH Medicare ,$738.66 ,58.75% of billed charges or 125% of CAH Medicare ,$608.66 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$590.93 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$738.66 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$590.93 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$590.93 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$590.93 ,47% of billed charges or 100% of CAH Medicare ,$590.93 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$738.66 ,"$1,257.30 "
Outpatient Medical Services,CT,72131,"CT Scan, Lumbar Spine without contrast",352,"$1,607.00 ",$944.11 ,58.75% of billed charges or 125% of CAH Medicare ,$944.11 ,58.75% of billed charges or 125% of CAH Medicare ,$777.95 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$755.29 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$944.11 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$755.29 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$755.29 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$755.29 ,47% of billed charges or 100% of CAH Medicare ,$755.29 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$944.11 ,"$1,607.00 "
Outpatient Medical Services,RADIOLOGY,72170,Pelvis 1 or 2 Views,320,$183.90 ,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,$89.03 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,$35.20 ,100% AR Medicaid ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$35.20 ,100% AR Medicaid ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$35.20 ,$284.64 ,$183.90 
Outpatient Medical Services,CT,72192,"CT Scan, Pelvis without Contrast",352,"$1,538.00 ",$903.58 ,58.75% of billed charges or 125% of CAH Medicare ,$903.58 ,58.75% of billed charges or 125% of CAH Medicare ,$744.55 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$722.86 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$903.58 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$722.86 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$722.86 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$722.86 ,47% of billed charges or 100% of CAH Medicare ,$722.86 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$903.58 ,"$1,538.00 "
Outpatient Medical Services,CT,72193,"CT Scan, Pelvis, With Contrast  *",352,"$1,461.00 ",$858.34 ,58.75% of billed charges or 125% of CAH Medicare ,$858.34 ,58.75% of billed charges or 125% of CAH Medicare ,$707.27 ,48.41% of billed charges or 125% of CAH Medicare ,$174.94 ,100% of custom fee schedule,$174.94 ,100% of custom fee schedule,$686.67 ,47% of billed charges or 100% of CAH Medicare ,$174.94 ,100% of custom fee schedule,$858.34 ,58.75% of billed charges or 125% of CAH Medicare ,$75.19 ,100% AR Medicaid ,$686.67 ,47% of billed charges or 100% of CAH Medicare ,$75.19 ,100% AR Medicaid ,$686.67 ,47% of billed charges or 100% of CAH Medicare ,$467.02 ,160% for custom fee schedule,$686.67 ,47% of billed charges or 100% of CAH Medicare ,$686.67 ,47% of billed charges or 100% of CAH Medicare ,$75.19 ,$858.34 ,"$1,461.00 "
Outpatient Medical Services,RADIOLOGY,72220,Sacrum 2 Views,320,$180.40 ,$105.99 ,58.75% of billed charges or 125% of CAH Medicare ,$105.99 ,58.75% of billed charges or 125% of CAH Medicare ,$87.33 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$84.79 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$105.99 ,58.75% of billed charges or 125% of CAH Medicare ,$35.20 ,100% AR Medicaid ,$84.79 ,47% of billed charges or 100% of CAH Medicare ,$35.20 ,100% AR Medicaid ,$84.79 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$84.79 ,47% of billed charges or 100% of CAH Medicare ,$84.79 ,47% of billed charges or 100% of CAH Medicare ,$35.20 ,$211.49 ,$180.40 
Outpatient Medical Services,RADIOLOGY,73000,Clavicle 2 Views,320,$152.00 ,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,$73.58 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,$27.50 ,100% AR Medicaid ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$27.50 ,100% AR Medicaid ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$27.50 ,$211.49 ,$152.00 
Outpatient Medical Services,LAB,73001,Follicle Stim Hormone,301,$90.00 ,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,$43.57 ,48.41% of billed charges or 125% of CAH Medicare ,$81.00 ,90% of total billed charges,$81.00 ,90% of total billed charges,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$81.00 ,90% of total billed charges,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$42.30 ,$81.00 ,$90.00 
Outpatient Medical Services,RADIOLOGY,73030,Shoulder 2 Views Right,320,$165.00 ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$79.88 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$38.50 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$38.50 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$38.50 ,$211.49 ,$165.00 
Outpatient Medical Services,RADIOLOGY,73030,Shoulder 2 views Left,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$38.50 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$38.50 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$38.50 ,$211.49 ,$181.50 
Outpatient Medical Services,RADIOLOGY,73060,Humerous 2 Views Right,320,$242.00 ,$142.18 ,58.75% of billed charges or 125% of CAH Medicare ,$142.18 ,58.75% of billed charges or 125% of CAH Medicare ,$117.15 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$113.74 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$142.18 ,58.75% of billed charges or 125% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$113.74 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$113.74 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$113.74 ,47% of billed charges or 100% of CAH Medicare ,$113.74 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,$211.49 ,$242.00 
Outpatient Medical Services,RADIOLOGY,73060,Humerous 2 Views Left,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,$211.49 ,$181.50 
Outpatient Medical Services,RADIOLOGY,73070,Elbow 2 Views Left,320,$184.25 ,$108.25 ,58.75% of billed charges or 125% of CAH Medicare ,$108.25 ,58.75% of billed charges or 125% of CAH Medicare ,$89.20 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$86.60 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$108.25 ,58.75% of billed charges or 125% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$86.60 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$86.60 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$86.60 ,47% of billed charges or 100% of CAH Medicare ,$86.60 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,$211.49 ,$184.25 
Outpatient Medical Services,RADIOLOGY,73070,Elbow 2 Views Right,320,$167.50 ,$98.41 ,58.75% of billed charges or 125% of CAH Medicare ,$98.41 ,58.75% of billed charges or 125% of CAH Medicare ,$81.09 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$78.73 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$98.41 ,58.75% of billed charges or 125% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$78.73 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$78.73 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$78.73 ,47% of billed charges or 100% of CAH Medicare ,$78.73 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,$211.49 ,$167.50 
Outpatient Medical Services,RADIOLOGY,73090,Rad & Ulna 2 Views Right,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,$211.49 ,$181.50 
Outpatient Medical Services,RADIOLOGY,73090,Rad & Ulna 2 Views Left,320,$165.00 ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$79.88 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,$211.49 ,$165.00 
Outpatient Medical Services,RADIOLOGY,73110,Wrist 3 Views Left,320,$159.00 ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$76.97 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$37.77 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$37.77 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$37.77 ,$211.49 ,$159.00 
Outpatient Medical Services,RADIOLOGY,73110,Wrist 3 Views Right,320,$174.90 ,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$84.67 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$37.77 ,100% AR Medicaid ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$37.77 ,100% AR Medicaid ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$37.77 ,$211.49 ,$174.90 
Outpatient Medical Services,RADIOLOGY,73130,Hand 3 Views Right or Left,320,$159.00 ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$76.97 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$40.00 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$40.00 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$40.00 ,$211.49 ,$159.00 
Outpatient Medical Services,RADIOLOGY,73502,Hip Uni 2 views,320,$189.20 ,$111.16 ,58.75% of billed charges or 125% of CAH Medicare ,$111.16 ,58.75% of billed charges or 125% of CAH Medicare ,$91.59 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$88.92 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$111.16 ,58.75% of billed charges or 125% of CAH Medicare ,$39.49 ,100% AR Medicaid ,$88.92 ,47% of billed charges or 100% of CAH Medicare ,$39.49 ,100% AR Medicaid ,$88.92 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$88.92 ,47% of billed charges or 100% of CAH Medicare ,$88.92 ,47% of billed charges or 100% of CAH Medicare ,$39.49 ,$211.49 ,$189.20 
Outpatient Medical Services,RADIOLOGY,73521,Hip Bilat 2 Views,320,$236.95 ,$139.21 ,58.75% of billed charges or 125% of CAH Medicare ,$139.21 ,58.75% of billed charges or 125% of CAH Medicare ,$114.71 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$111.37 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$139.21 ,58.75% of billed charges or 125% of CAH Medicare ,$38.16 ,100% AR Medicaid ,$111.37 ,47% of billed charges or 100% of CAH Medicare ,$38.16 ,100% AR Medicaid ,$111.37 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$111.37 ,47% of billed charges or 100% of CAH Medicare ,$111.37 ,47% of billed charges or 100% of CAH Medicare ,$38.16 ,$284.64 ,$236.95 
Outpatient Medical Services,RADIOLOGY,73552,Femur 2 Views  LF,320,$200.00 ,$117.50 ,58.75% of billed charges or 125% of CAH Medicare ,$117.50 ,58.75% of billed charges or 125% of CAH Medicare ,$96.82 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$94.00 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$117.50 ,58.75% of billed charges or 125% of CAH Medicare ,$30.96 ,100% AR Medicaid ,$94.00 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% AR Medicaid ,$94.00 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$94.00 ,47% of billed charges or 100% of CAH Medicare ,$94.00 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$211.49 ,$200.00 
Outpatient Medical Services,RADIOLOGY,73552,Femur 2 Views Right,320,$199.65 ,$117.29 ,58.75% of billed charges or 125% of CAH Medicare ,$117.29 ,58.75% of billed charges or 125% of CAH Medicare ,$96.65 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$93.84 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$117.29 ,58.75% of billed charges or 125% of CAH Medicare ,$30.96 ,100% AR Medicaid ,$93.84 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% AR Medicaid ,$93.84 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$93.84 ,47% of billed charges or 100% of CAH Medicare ,$93.84 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$211.49 ,$199.65 
Outpatient Medical Services,RADIOLOGY,73560,Knee 1-2 Views Right,320,$174.90 ,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$84.67 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$102.75 ,58.75% of billed charges or 125% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$82.20 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,$211.49 ,$174.90 
Outpatient Medical Services,RADIOLOGY,73560,Knee 1-2 Views Left,320,$175.00 ,$102.81 ,58.75% of billed charges or 125% of CAH Medicare ,$102.81 ,58.75% of billed charges or 125% of CAH Medicare ,$84.72 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$82.25 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$102.81 ,58.75% of billed charges or 125% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$82.25 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$82.25 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$82.25 ,47% of billed charges or 100% of CAH Medicare ,$82.25 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,$211.49 ,$175.00 
Outpatient Medical Services,RADIOLOGY,73590,Tib/Fib 2 Views Left,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$37.30 ,$211.49 ,$181.50 
Outpatient Medical Services,RADIOLOGY,73600,Ankle 2 views Bilateral,320,$254.00 ,$149.23 ,58.75% of billed charges or 125% of CAH Medicare ,$149.23 ,58.75% of billed charges or 125% of CAH Medicare ,$122.96 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$119.38 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$149.23 ,58.75% of billed charges or 125% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$119.38 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,100% AR Medicaid ,$119.38 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$119.38 ,47% of billed charges or 100% of CAH Medicare ,$119.38 ,47% of billed charges or 100% of CAH Medicare ,$33.00 ,$211.49 ,$254.00 
Outpatient Medical Services,RADIOLOGY,73610,Ankle 3 Views Left or Right,320,$165.00 ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$79.88 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$37.40 ,$211.49 ,$165.00 
Outpatient Medical Services,RADIOLOGY,73630,Foot Rad 3 Views Left,320,$181.50 ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$87.86 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$106.63 ,58.75% of billed charges or 125% of CAH Medicare ,$44.00 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$44.00 ,100% AR Medicaid ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$85.31 ,47% of billed charges or 100% of CAH Medicare ,$44.00 ,$211.49 ,$181.50 
Outpatient Medical Services,RADIOLOGY,73630,Foot Rad 3 Views Right,320,$165.00 ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$79.88 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$44.00 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$44.00 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$44.00 ,$211.49 ,$165.00 
Outpatient Medical Services,LAB,73970,Parah Hormone PTH,301,$333.00 ,$195.64 ,58.75% of billed charges or 125% of CAH Medicare ,$195.64 ,58.75% of billed charges or 125% of CAH Medicare ,$161.21 ,48.41% of billed charges or 125% of CAH Medicare ,$299.70 ,90% of total billed charges,$299.70 ,90% of total billed charges,$156.51 ,47% of billed charges or 100% of CAH Medicare ,$299.70 ,90% of total billed charges,$195.64 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$156.51 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$156.51 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$156.51 ,47% of billed charges or 100% of CAH Medicare ,$156.51 ,47% of billed charges or 100% of CAH Medicare ,$156.51 ,$299.70 ,$333.00 
Outpatient Medical Services,RADIOLOGY,74018,Abdomen 1 view,320,$232.95 ,$136.86 ,58.75% of billed charges or 125% of CAH Medicare ,$136.86 ,58.75% of billed charges or 125% of CAH Medicare ,$112.77 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$109.49 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$136.86 ,58.75% of billed charges or 125% of CAH Medicare ,$31.34 ,100% AR Medicaid ,$109.49 ,47% of billed charges or 100% of CAH Medicare ,$31.34 ,100% AR Medicaid ,$109.49 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$109.49 ,47% of billed charges or 100% of CAH Medicare ,$109.49 ,47% of billed charges or 100% of CAH Medicare ,$31.34 ,$211.49 ,$232.95 
Outpatient Medical Services,RADIOLOGY,74019,Abdomen 2 Views,320,$231.10 ,$135.77 ,58.75% of billed charges or 125% of CAH Medicare ,$135.77 ,58.75% of billed charges or 125% of CAH Medicare ,$111.88 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$108.62 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$135.77 ,58.75% of billed charges or 125% of CAH Medicare ,$38.38 ,100% AR Medicaid ,$108.62 ,47% of billed charges or 100% of CAH Medicare ,$38.38 ,100% AR Medicaid ,$108.62 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$108.62 ,47% of billed charges or 100% of CAH Medicare ,$108.62 ,47% of billed charges or 100% of CAH Medicare ,$38.38 ,$284.64 ,$231.10 
Outpatient Medical Services,RADIOLOGY,74022,Acute Abdomen Series,320,$300.30 ,$176.43 ,58.75% of billed charges or 125% of CAH Medicare ,$176.43 ,58.75% of billed charges or 125% of CAH Medicare ,$145.38 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$141.14 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$176.43 ,58.75% of billed charges or 125% of CAH Medicare ,$57.20 ,100% AR Medicaid ,$141.14 ,47% of billed charges or 100% of CAH Medicare ,$57.20 ,100% AR Medicaid ,$141.14 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$141.14 ,47% of billed charges or 100% of CAH Medicare ,$141.14 ,47% of billed charges or 100% of CAH Medicare ,$57.20 ,$284.64 ,$300.30 
Outpatient Medical Services,LAB,74156,Protein Total Urine,307,$22.48 ,$13.21 ,58.75% of billed charges or 125% of CAH Medicare ,$13.21 ,58.75% of billed charges or 125% of CAH Medicare ,$10.88 ,48.41% of billed charges or 125% of CAH Medicare ,$20.23 ,90% of total billed charges,$20.23 ,90% of total billed charges,$10.57 ,47% of billed charges or 100% of CAH Medicare ,$20.23 ,90% of total billed charges,$13.21 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$10.57 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$10.57 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$10.57 ,47% of billed charges or 100% of CAH Medicare ,$10.57 ,47% of billed charges or 100% of CAH Medicare ,$10.57 ,$20.23 ,$22.48 
Outpatient Medical Services,CT,74177,"CT Scan, Abdomen and Pelvis with Contrast  *",352,"$2,191.50 ","$1,287.51 ",58.75% of billed charges or 125% of CAH Medicare ,"$1,287.51 ",58.75% of billed charges or 125% of CAH Medicare ,"$1,060.91 ",48.41% of billed charges or 125% of CAH Medicare ,$366.59 ,100% of custom fee schedule,$366.59 ,100% of custom fee schedule,"$1,030.01 ",47% of billed charges or 100% of CAH Medicare ,$366.59 ,100% of custom fee schedule,"$1,287.51 ",58.75% of billed charges or 125% of CAH Medicare ,$155.01 ,100% AR Medicaid ,"$1,030.01 ",47% of billed charges or 100% of CAH Medicare ,$155.01 ,100% AR Medicaid ,"$1,030.01 ",47% of billed charges or 100% of CAH Medicare ,$962.78 ,160% for custom fee schedule,"$1,030.01 ",47% of billed charges or 100% of CAH Medicare ,"$1,030.01 ",47% of billed charges or 100% of CAH Medicare ,$155.01 ,"$1,287.51 ","$2,191.50 "
Outpatient Medical Services,ULTRASOUND,76536,U/S Head/Neck (Thyroid),402,$318.00 ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$153.94 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$94.60 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$94.60 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$94.60 ,$284.64 ,$318.00 
Outpatient Medical Services,ULTRASOUND,76700,Ultrasound of Abdomen   *,402,$445.00 ,$261.44 ,58.75% of billed charges or 125% of CAH Medicare ,$261.44 ,58.75% of billed charges or 125% of CAH Medicare ,$215.42 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$209.15 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$261.44 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$209.15 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$209.15 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$209.15 ,47% of billed charges or 100% of CAH Medicare ,$209.15 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$284.64 ,$445.00 
Outpatient Medical Services,ULTRASOUND,76705,U/S Abdomen Single Organ,402,$350.00 ,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$169.44 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$284.64 ,$350.00 
Outpatient Medical Services,ULTRASOUND,76775,U/S Abdomen Renal-Aorta Limited,402,$318.00 ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$153.94 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$61.63 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$61.63 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$61.63 ,$284.64 ,$318.00 
Outpatient Medical Services,ULTRASOUND,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,$572.00 ,$336.05 ,58.75% of billed charges or 125% of CAH Medicare ,$336.05 ,58.75% of billed charges or 125% of CAH Medicare ,$276.91 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$268.84 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$336.05 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$268.84 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$268.84 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$268.84 ,47% of billed charges or 100% of CAH Medicare ,$268.84 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$336.05 ,$572.00 
Outpatient Medical Services,ULTRASOUND,76830,Ultrasound Pelvis through Vagina*,402,$318.00 ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$153.94 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$284.64 ,$318.00 
Outpatient Medical Services,ULTRASOUND,76856,U/S Pelvis,402,$462.00 ,$271.43 ,58.75% of billed charges or 125% of CAH Medicare ,$271.43 ,58.75% of billed charges or 125% of CAH Medicare ,$223.65 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$217.14 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$271.43 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$217.14 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,100% AR Medicaid ,$217.14 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$217.14 ,47% of billed charges or 100% of CAH Medicare ,$217.14 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,$284.64 ,$462.00 
Outpatient Medical Services,ULTRASOUND,76857,U/S Pelvis Limited,402,$270.00 ,$158.63 ,58.75% of billed charges or 125% of CAH Medicare ,$158.63 ,58.75% of billed charges or 125% of CAH Medicare ,$130.71 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$126.90 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$158.63 ,58.75% of billed charges or 125% of CAH Medicare ,$19.66 ,100% AR Medicaid ,$126.90 ,47% of billed charges or 100% of CAH Medicare ,$19.66 ,100% AR Medicaid ,$126.90 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$126.90 ,47% of billed charges or 100% of CAH Medicare ,$126.90 ,47% of billed charges or 100% of CAH Medicare ,$19.66 ,$284.64 ,$270.00 
Outpatient Medical Services,ULTRASOUND,76870,U/S Testicular,402,$318.00 ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$153.94 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$186.83 ,58.75% of billed charges or 125% of CAH Medicare ,$101.20 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$101.20 ,100% AR Medicaid ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$284.64 ,160% for custom fee schedule,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$149.46 ,47% of billed charges or 100% of CAH Medicare ,$101.20 ,$284.64 ,$318.00 
Outpatient Medical Services,CT,77078,"CT Scan, Bone Density",350,$621.00 ,$364.84 ,58.75% of billed charges or 125% of CAH Medicare ,$364.84 ,58.75% of billed charges or 125% of CAH Medicare ,$300.63 ,48.41% of billed charges or 125% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$76.62 ,100% of custom fee schedule,$291.87 ,47% of billed charges or 100% of CAH Medicare ,$76.62 ,100% of custom fee schedule,$364.84 ,58.75% of billed charges or 125% of CAH Medicare ,$34.05 ,100% AR Medicaid ,$291.87 ,47% of billed charges or 100% of CAH Medicare ,$34.05 ,100% AR Medicaid ,$291.87 ,47% of billed charges or 100% of CAH Medicare ,$211.49 ,160% for custom fee schedule,$291.87 ,47% of billed charges or 100% of CAH Medicare ,$291.87 ,47% of billed charges or 100% of CAH Medicare ,$34.05 ,$364.84 ,$621.00 
Outpatient Medical Services,LAB,80048,Chem 8 Basic Metabolic Panel    *,301,$216.70 ,$127.31 ,58.75% of billed charges or 125% of CAH Medicare ,$127.31 ,58.75% of billed charges or 125% of CAH Medicare ,$104.90 ,48.41% of billed charges or 125% of CAH Medicare ,$10.34 ,100% of custom fee schedule,$10.34 ,100% of custom fee schedule,$101.85 ,47% of billed charges or 100% of CAH Medicare ,$10.34 ,100% of custom fee schedule,$127.31 ,58.75% of billed charges or 125% of CAH Medicare ,$9.07 ,100% AR Medicaid ,$101.85 ,47% of billed charges or 100% of CAH Medicare ,$12.09 ,100% AR Medicaid ,$101.85 ,47% of billed charges or 100% of CAH Medicare ,$6.85 ,90% for custom fee schedule,$101.85 ,47% of billed charges or 100% of CAH Medicare ,$101.85 ,47% of billed charges or 100% of CAH Medicare ,$6.85 ,$127.31 ,$216.70 
Outpatient Medical Services,LAB,80051,Profile Electrolite,301,$425.60 ,$250.04 ,58.75% of billed charges or 125% of CAH Medicare ,$250.04 ,58.75% of billed charges or 125% of CAH Medicare ,$206.03 ,48.41% of billed charges or 125% of CAH Medicare ,$8.57 ,100% of custom fee schedule,$8.57 ,100% of custom fee schedule,$200.03 ,47% of billed charges or 100% of CAH Medicare ,$8.57 ,100% of custom fee schedule,$250.04 ,58.75% of billed charges or 125% of CAH Medicare ,$7.51 ,100% AR Medicaid ,$200.03 ,47% of billed charges or 100% of CAH Medicare ,$10.01 ,100% AR Medicaid ,$200.03 ,47% of billed charges or 100% of CAH Medicare ,$5.68 ,90% for custom fee schedule,$200.03 ,47% of billed charges or 100% of CAH Medicare ,$200.03 ,47% of billed charges or 100% of CAH Medicare ,$5.68 ,$250.04 ,$425.60 
Outpatient Medical Services,LAB,80053,"Chem 14  Blood Test, Comprehensive group of Blood   *",301,$306.15 ,$179.86 ,58.75% of billed charges or 125% of CAH Medicare ,$179.86 ,58.75% of billed charges or 125% of CAH Medicare ,$148.21 ,48.41% of billed charges or 125% of CAH Medicare ,$12.91 ,100% of custom fee schedule,$12.91 ,100% of custom fee schedule,$143.89 ,47% of billed charges or 100% of CAH Medicare ,$12.91 ,100% of custom fee schedule,$179.86 ,58.75% of billed charges or 125% of CAH Medicare ,$11.33 ,100% AR Medicaid ,$143.89 ,47% of billed charges or 100% of CAH Medicare ,$15.10 ,100% AR Medicaid ,$143.89 ,47% of billed charges or 100% of CAH Medicare ,$8.55 ,90% for custom fee schedule,$143.89 ,47% of billed charges or 100% of CAH Medicare ,$143.89 ,47% of billed charges or 100% of CAH Medicare ,$8.55 ,$179.86 ,$306.15 
Outpatient Medical Services,LAB,80061,"Lipid Panel Blood Test, (cholesterol and trigycerides   *",301,$151.25 ,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$73.22 ,48.41% of billed charges or 125% of CAH Medicare ,$16.37 ,100% of custom fee schedule,$16.37 ,100% of custom fee schedule,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$16.37 ,100% of custom fee schedule,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$13.62 ,100% AR Medicaid ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$18.16 ,100% AR Medicaid ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$10.85 ,90% for custom fee schedule,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$10.85 ,$88.86 ,$151.25 
Outpatient Medical Services,LAB,80069,Kidney (Renal)Function Panel Test   *,301,$167.00 ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$80.84 ,48.41% of billed charges or 125% of CAH Medicare ,$10.62 ,100% of custom fee schedule,$10.62 ,100% of custom fee schedule,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$10.62 ,100% of custom fee schedule,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$9.30 ,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$12.40 ,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$7.03 ,90% for custom fee schedule,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$7.03 ,$98.11 ,$167.00 
Outpatient Medical Services,LAB,80069,Renal Function Panel,301,$167.00 ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$80.84 ,48.41% of billed charges or 125% of CAH Medicare ,$10.62 ,100% of custom fee schedule,$10.62 ,100% of custom fee schedule,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$10.62 ,100% of custom fee schedule,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$9.30 ,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$12.40 ,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$7.03 ,90% for custom fee schedule,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$7.03 ,$98.11 ,$167.00 
Outpatient Medical Services,LAB,80074,Acute Hepatitispan,302,$350.00 ,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$169.44 ,48.41% of billed charges or 125% of CAH Medicare ,$58.22 ,100% of custom fee schedule,$58.22 ,100% of custom fee schedule,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$58.22 ,100% of custom fee schedule,$205.63 ,58.75% of billed charges or 125% of CAH Medicare ,$51.01 ,100% AR Medicaid ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$68.01 ,100% AR Medicaid ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$38.58 ,90% for custom fee schedule,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$164.50 ,47% of billed charges or 100% of CAH Medicare ,$38.58 ,$205.63 ,$350.00 
Outpatient Medical Services,LAB,80076,Hepatic Function Panel,300,$186.00 ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$90.04 ,48.41% of billed charges or 125% of CAH Medicare ,$9.99 ,100% of custom fee schedule,$9.99 ,100% of custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$9.99 ,100% of custom fee schedule,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$8.75 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$11.67 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$6.62 ,90% for custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$6.62 ,$109.28 ,$186.00 
Outpatient Medical Services,LAB,80076,Liver/Hepatic Function Blood Test Panel *,301,$186.00 ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$90.04 ,48.41% of billed charges or 125% of CAH Medicare ,$9.99 ,100% of custom fee schedule,$9.99 ,100% of custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$9.99 ,100% of custom fee schedule,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$8.75 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$11.67 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$6.62 ,90% for custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$6.62 ,$109.28 ,$186.00 
Outpatient Medical Services,LAB,80156,Tegretol Level,301,$137.50 ,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,$66.56 ,48.41% of billed charges or 125% of CAH Medicare ,$17.80 ,100% of custom fee schedule,$17.80 ,100% of custom fee schedule,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$17.80 ,100% of custom fee schedule,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,$15.59 ,100% AR Medicaid ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$20.79 ,100% AR Medicaid ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$11.80 ,90% for custom fee schedule,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$11.80 ,$80.78 ,$137.50 
Outpatient Medical Services,LAB,80162,Digoxin,300,$223.85 ,$131.51 ,58.75% of billed charges or 125% of CAH Medicare ,$131.51 ,58.75% of billed charges or 125% of CAH Medicare ,$108.37 ,48.41% of billed charges or 125% of CAH Medicare ,$16.23 ,100% of custom fee schedule,$16.23 ,100% of custom fee schedule,$105.21 ,47% of billed charges or 100% of CAH Medicare ,$16.23 ,100% of custom fee schedule,$131.51 ,58.75% of billed charges or 125% of CAH Medicare ,$14.22 ,100% AR Medicaid ,$105.21 ,47% of billed charges or 100% of CAH Medicare ,$18.96 ,100% AR Medicaid ,$105.21 ,47% of billed charges or 100% of CAH Medicare ,$10.76 ,90% for custom fee schedule,$105.21 ,47% of billed charges or 100% of CAH Medicare ,$105.21 ,47% of billed charges or 100% of CAH Medicare ,$10.76 ,$131.51 ,$223.85 
Outpatient Medical Services,LAB,80164,Depakote,300,$189.00 ,$111.04 ,58.75% of billed charges or 125% of CAH Medicare ,$111.04 ,58.75% of billed charges or 125% of CAH Medicare ,$91.49 ,48.41% of billed charges or 125% of CAH Medicare ,$16.56 ,100% of custom fee schedule,$16.56 ,100% of custom fee schedule,$88.83 ,47% of billed charges or 100% of CAH Medicare ,$16.56 ,100% of custom fee schedule,$111.04 ,58.75% of billed charges or 125% of CAH Medicare ,$14.51 ,100% AR Medicaid ,$88.83 ,47% of billed charges or 100% of CAH Medicare ,$19.34 ,100% AR Medicaid ,$88.83 ,47% of billed charges or 100% of CAH Medicare ,$10.97 ,90% for custom fee schedule,$88.83 ,47% of billed charges or 100% of CAH Medicare ,$88.83 ,47% of billed charges or 100% of CAH Medicare ,$10.97 ,$111.04 ,$189.00 
Outpatient Medical Services,LAB,80177,Levetiracetam (Keppra),301,$57.00 ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$27.59 ,48.41% of billed charges or 125% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$16.20 ,100% of custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$13.57 ,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$18.09 ,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,90% for custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,$33.49 ,$57.00 
Outpatient Medical Services,LAB,80178,Lithium,301,$100.10 ,$58.81 ,58.75% of billed charges or 125% of CAH Medicare ,$58.81 ,58.75% of billed charges or 125% of CAH Medicare ,$48.46 ,48.41% of billed charges or 125% of CAH Medicare ,$8.09 ,100% of custom fee schedule,$8.09 ,100% of custom fee schedule,$47.05 ,47% of billed charges or 100% of CAH Medicare ,$8.09 ,100% of custom fee schedule,$58.81 ,58.75% of billed charges or 125% of CAH Medicare ,$7.01 ,100% AR Medicaid ,$47.05 ,47% of billed charges or 100% of CAH Medicare ,$9.34 ,100% AR Medicaid ,$47.05 ,47% of billed charges or 100% of CAH Medicare ,$5.36 ,90% for custom fee schedule,$47.05 ,47% of billed charges or 100% of CAH Medicare ,$47.05 ,47% of billed charges or 100% of CAH Medicare ,$5.36 ,$58.81 ,$100.10 
Outpatient Medical Services,LAB,80183,Oxcabazepine,301,$71.00 ,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$34.37 ,48.41% of billed charges or 125% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$16.20 ,100% of custom fee schedule,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$13.55 ,100% AR Medicaid ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$18.06 ,100% AR Medicaid ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,90% for custom fee schedule,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,$41.71 ,$71.00 
Outpatient Medical Services,LAB,80184,Phenobard,301,$159.00 ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$76.97 ,48.41% of billed charges or 125% of CAH Medicare ,$15.68 ,100% of custom fee schedule,$15.68 ,100% of custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$15.68 ,100% of custom fee schedule,$93.41 ,58.75% of billed charges or 125% of CAH Medicare ,$12.27 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$16.36 ,100% AR Medicaid ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$12.39 ,90% for custom fee schedule,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$74.73 ,47% of billed charges or 100% of CAH Medicare ,$12.27 ,$93.41 ,$159.00 
Outpatient Medical Services,LAB,80185,Dilatin,301,$215.00 ,$126.31 ,58.75% of billed charges or 125% of CAH Medicare ,$126.31 ,58.75% of billed charges or 125% of CAH Medicare ,$104.08 ,48.41% of billed charges or 125% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$16.20 ,100% of custom fee schedule,$101.05 ,47% of billed charges or 100% of CAH Medicare ,$16.20 ,100% of custom fee schedule,$126.31 ,58.75% of billed charges or 125% of CAH Medicare ,$14.20 ,100% AR Medicaid ,$101.05 ,47% of billed charges or 100% of CAH Medicare ,$18.93 ,100% AR Medicaid ,$101.05 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,90% for custom fee schedule,$101.05 ,47% of billed charges or 100% of CAH Medicare ,$101.05 ,47% of billed charges or 100% of CAH Medicare ,$10.74 ,$126.31 ,$215.00 
Outpatient Medical Services,LAB,80188,Primidone,301,$105.00 ,$61.69 ,58.75% of billed charges or 125% of CAH Medicare ,$61.69 ,58.75% of billed charges or 125% of CAH Medicare ,$50.83 ,48.41% of billed charges or 125% of CAH Medicare ,$20.28 ,100% of custom fee schedule,$20.28 ,100% of custom fee schedule,$49.35 ,47% of billed charges or 100% of CAH Medicare ,$20.28 ,100% of custom fee schedule,$61.69 ,58.75% of billed charges or 125% of CAH Medicare ,$17.77 ,100% AR Medicaid ,$49.35 ,47% of billed charges or 100% of CAH Medicare ,$23.69 ,100% AR Medicaid ,$49.35 ,47% of billed charges or 100% of CAH Medicare ,$13.44 ,90% for custom fee schedule,$49.35 ,47% of billed charges or 100% of CAH Medicare ,$49.35 ,47% of billed charges or 100% of CAH Medicare ,$13.44 ,$61.69 ,$105.00 
Outpatient Medical Services,LAB,80197,Tacrolimus FK506,301,$179.00 ,$105.16 ,58.75% of billed charges or 125% of CAH Medicare ,$105.16 ,58.75% of billed charges or 125% of CAH Medicare ,$86.65 ,48.41% of billed charges or 125% of CAH Medicare ,$16.79 ,100% of custom fee schedule,$16.79 ,100% of custom fee schedule,$84.13 ,47% of billed charges or 100% of CAH Medicare ,$16.79 ,100% of custom fee schedule,$105.16 ,58.75% of billed charges or 125% of CAH Medicare ,$14.70 ,100% AR Medicaid ,$84.13 ,47% of billed charges or 100% of CAH Medicare ,$19.60 ,100% AR Medicaid ,$84.13 ,47% of billed charges or 100% of CAH Medicare ,$11.12 ,90% for custom fee schedule,$84.13 ,47% of billed charges or 100% of CAH Medicare ,$84.13 ,47% of billed charges or 100% of CAH Medicare ,$11.12 ,$105.16 ,$179.00 
Outpatient Medical Services,LAB,80202,Vancomycin Peak,301,$151.25 ,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$73.22 ,48.41% of billed charges or 125% of CAH Medicare ,$16.56 ,100% of custom fee schedule,$16.56 ,100% of custom fee schedule,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$16.56 ,100% of custom fee schedule,$88.86 ,58.75% of billed charges or 125% of CAH Medicare ,$14.51 ,100% AR Medicaid ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$19.34 ,100% AR Medicaid ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$10.97 ,90% for custom fee schedule,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$71.09 ,47% of billed charges or 100% of CAH Medicare ,$10.97 ,$88.86 ,$151.25 
Outpatient Medical Services,LAB,80307,Drug Screen Reference Lab,300,$126.00 ,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,$61.00 ,48.41% of billed charges or 125% of CAH Medicare ,$71.12 ,100% of custom fee schedule,$71.12 ,100% of custom fee schedule,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$71.12 ,100% of custom fee schedule,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,$59.86 ,100% AR Medicaid ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$79.81 ,100% AR Medicaid ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$50.34 ,90% for custom fee schedule,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$50.34 ,$79.81 ,$126.00 
Outpatient Medical Services,LAB,80320,Alcohol,301,$139.70 ,$82.07 ,58.75% of billed charges or 125% of CAH Medicare ,$82.07 ,58.75% of billed charges or 125% of CAH Medicare ,$67.63 ,48.41% of billed charges or 125% of CAH Medicare ,$21.25 ,100% of custom fee schedule,$21.25 ,100% of custom fee schedule,$65.66 ,47% of billed charges or 100% of CAH Medicare ,$21.25 ,100% of custom fee schedule,$82.07 ,58.75% of billed charges or 125% of CAH Medicare ,$12.17 ,100% AR Medicaid ,$65.66 ,47% of billed charges or 100% of CAH Medicare ,$16.22 ,100% AR Medicaid ,$65.66 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$65.66 ,47% of billed charges or 100% of CAH Medicare ,$65.66 ,47% of billed charges or 100% of CAH Medicare ,$12.17 ,$82.07 ,$139.70 
Outpatient Medical Services,LAB,80323,Cotinine,300,$90.00 ,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,$43.57 ,48.41% of billed charges or 125% of CAH Medicare ,$64.25 ,100% of custom fee schedule,$64.25 ,100% of custom fee schedule,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$64.25 ,100% of custom fee schedule,$52.88 ,58.75% of billed charges or 125% of CAH Medicare ,$36.77 ,100% AR Medicaid ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$49.02 ,100% AR Medicaid ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$42.30 ,47% of billed charges or 100% of CAH Medicare ,$36.77 ,$64.25 ,$90.00 
Outpatient Medical Services,LAB,80323,Nicotine,301,$96.00 ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$46.47 ,48.41% of billed charges or 125% of CAH Medicare ,$64.25 ,100% of custom fee schedule,$64.25 ,100% of custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$64.25 ,100% of custom fee schedule,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$36.77 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$49.02 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$36.77 ,$64.25 ,$96.00 
Outpatient Medical Services,LAB,80329,Acetaminophen,301,$163.90 ,$96.29 ,58.75% of billed charges or 125% of CAH Medicare ,$96.29 ,58.75% of billed charges or 125% of CAH Medicare ,$79.34 ,48.41% of billed charges or 125% of CAH Medicare ,$15.19 ,100% of custom fee schedule,$15.19 ,100% of custom fee schedule,$77.03 ,47% of billed charges or 100% of CAH Medicare ,$15.19 ,100% of custom fee schedule,$96.29 ,58.75% of billed charges or 125% of CAH Medicare ,$8.69 ,100% AR Medicaid ,$77.03 ,47% of billed charges or 100% of CAH Medicare ,$11.59 ,100% AR Medicaid ,$77.03 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$77.03 ,47% of billed charges or 100% of CAH Medicare ,$77.03 ,47% of billed charges or 100% of CAH Medicare ,$8.69 ,$96.29 ,$163.90 
Outpatient Medical Services,LAB,81001,Urinalysis Test With Exam Using Microscope  *,307,$75.90 ,$44.59 ,58.75% of billed charges or 125% of CAH Medicare ,$44.59 ,58.75% of billed charges or 125% of CAH Medicare ,$36.74 ,48.41% of billed charges or 125% of CAH Medicare ,$3.87 ,100% of custom fee schedule,$3.87 ,100% of custom fee schedule,$35.67 ,47% of billed charges or 100% of CAH Medicare ,$3.87 ,100% of custom fee schedule,$44.59 ,58.75% of billed charges or 125% of CAH Medicare ,$3.39 ,100% AR Medicaid ,$35.67 ,47% of billed charges or 100% of CAH Medicare ,$4.52 ,100% AR Medicaid ,$35.67 ,47% of billed charges or 100% of CAH Medicare ,$2.57 ,90% for custom fee schedule,$35.67 ,47% of billed charges or 100% of CAH Medicare ,$35.67 ,47% of billed charges or 100% of CAH Medicare ,$2.57 ,$44.59 ,$75.90 
Outpatient Medical Services,LAB,81025,Factor V Leiden Mutation,300,$330.00 ,$193.88 ,58.75% of billed charges or 125% of CAH Medicare ,$193.88 ,58.75% of billed charges or 125% of CAH Medicare ,$159.75 ,48.41% of billed charges or 125% of CAH Medicare ,$8.83 ,100% of custom fee schedule,$8.83 ,100% of custom fee schedule,$155.10 ,47% of billed charges or 100% of CAH Medicare ,$8.83 ,100% of custom fee schedule,$193.88 ,58.75% of billed charges or 125% of CAH Medicare ,$6.77 ,100% AR Medicaid ,$155.10 ,47% of billed charges or 100% of CAH Medicare ,$9.03 ,100% AR Medicaid ,$155.10 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$155.10 ,47% of billed charges or 100% of CAH Medicare ,$155.10 ,47% of billed charges or 100% of CAH Medicare ,$6.77 ,$193.88 ,$330.00 
Outpatient Medical Services,LAB,81025,HCG Slide (Urine Pregnancy),300,$50.00 ,$29.38 ,58.75% of billed charges or 125% of CAH Medicare ,$29.38 ,58.75% of billed charges or 125% of CAH Medicare ,$24.21 ,48.41% of billed charges or 125% of CAH Medicare ,$8.83 ,100% of custom fee schedule,$8.83 ,100% of custom fee schedule,$23.50 ,47% of billed charges or 100% of CAH Medicare ,$8.83 ,100% of custom fee schedule,$29.38 ,58.75% of billed charges or 125% of CAH Medicare ,$6.77 ,100% AR Medicaid ,$23.50 ,47% of billed charges or 100% of CAH Medicare ,$9.03 ,100% AR Medicaid ,$23.50 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$23.50 ,47% of billed charges or 100% of CAH Medicare ,$23.50 ,47% of billed charges or 100% of CAH Medicare ,$6.77 ,$29.38 ,$50.00 
Outpatient Medical Services,LAB,82009,Acetone-Serum,301,$44.00 ,$25.85 ,58.75% of billed charges or 125% of CAH Medicare ,$25.85 ,58.75% of billed charges or 125% of CAH Medicare ,$21.30 ,48.41% of billed charges or 125% of CAH Medicare ,$5.52 ,100% of custom fee schedule,$5.52 ,100% of custom fee schedule,$20.68 ,47% of billed charges or 100% of CAH Medicare ,$5.52 ,100% of custom fee schedule,$25.85 ,58.75% of billed charges or 125% of CAH Medicare ,$4.85 ,100% AR Medicaid ,$20.68 ,47% of billed charges or 100% of CAH Medicare ,$6.46 ,100% AR Medicaid ,$20.68 ,47% of billed charges or 100% of CAH Medicare ,$3.66 ,90% for custom fee schedule,$20.68 ,47% of billed charges or 100% of CAH Medicare ,$20.68 ,47% of billed charges or 100% of CAH Medicare ,$3.66 ,$25.85 ,$44.00 
Outpatient Medical Services,LAB,82024,"Acth, Plasma",301,$206.10 ,$121.08 ,58.75% of billed charges or 125% of CAH Medicare ,$121.08 ,58.75% of billed charges or 125% of CAH Medicare ,$99.77 ,48.41% of billed charges or 125% of CAH Medicare ,$47.20 ,100% of custom fee schedule,$47.20 ,100% of custom fee schedule,$96.87 ,47% of billed charges or 100% of CAH Medicare ,$47.20 ,100% of custom fee schedule,$121.08 ,58.75% of billed charges or 125% of CAH Medicare ,$17.75 ,100% AR Medicaid ,$96.87 ,47% of billed charges or 100% of CAH Medicare ,$23.66 ,100% AR Medicaid ,$96.87 ,47% of billed charges or 100% of CAH Medicare ,$31.28 ,90% for custom fee schedule,$96.87 ,47% of billed charges or 100% of CAH Medicare ,$96.87 ,47% of billed charges or 100% of CAH Medicare ,$17.75 ,$121.08 ,$206.10 
Outpatient Medical Services,LAB,82040,Albumin Serum,301,$58.10 ,$34.13 ,58.75% of billed charges or 125% of CAH Medicare ,$34.13 ,58.75% of billed charges or 125% of CAH Medicare ,$28.13 ,48.41% of billed charges or 125% of CAH Medicare ,$6.05 ,100% of custom fee schedule,$6.05 ,100% of custom fee schedule,$27.31 ,47% of billed charges or 100% of CAH Medicare ,$6.05 ,100% of custom fee schedule,$34.13 ,58.75% of billed charges or 125% of CAH Medicare ,$5.31 ,100% AR Medicaid ,$27.31 ,47% of billed charges or 100% of CAH Medicare ,$7.08 ,100% AR Medicaid ,$27.31 ,47% of billed charges or 100% of CAH Medicare ,$4.01 ,90% for custom fee schedule,$27.31 ,47% of billed charges or 100% of CAH Medicare ,$27.31 ,47% of billed charges or 100% of CAH Medicare ,$4.01 ,$34.13 ,$58.10 
Outpatient Medical Services,LAB,82043,"Nucriakbumin, Random Urine",307,$37.58 ,$22.08 ,58.75% of billed charges or 125% of CAH Medicare ,$22.08 ,58.75% of billed charges or 125% of CAH Medicare ,$18.19 ,48.41% of billed charges or 125% of CAH Medicare ,$7.06 ,100% of custom fee schedule,$7.06 ,100% of custom fee schedule,$17.66 ,47% of billed charges or 100% of CAH Medicare ,$7.06 ,100% of custom fee schedule,$22.08 ,58.75% of billed charges or 125% of CAH Medicare ,$6.20 ,100% AR Medicaid ,$17.66 ,47% of billed charges or 100% of CAH Medicare ,$8.27 ,100% AR Medicaid ,$17.66 ,47% of billed charges or 100% of CAH Medicare ,$4.68 ,90% for custom fee schedule,$17.66 ,47% of billed charges or 100% of CAH Medicare ,$17.66 ,47% of billed charges or 100% of CAH Medicare ,$4.68 ,$22.08 ,$37.58 
Outpatient Medical Services,LAB,82088,"Aldosterone, Serum",301,$204.75 ,$120.29 ,58.75% of billed charges or 125% of CAH Medicare ,$120.29 ,58.75% of billed charges or 125% of CAH Medicare ,$99.12 ,48.41% of billed charges or 125% of CAH Medicare ,$49.81 ,100% of custom fee schedule,$49.81 ,100% of custom fee schedule,$96.23 ,47% of billed charges or 100% of CAH Medicare ,$49.81 ,100% of custom fee schedule,$120.29 ,58.75% of billed charges or 125% of CAH Medicare ,$43.65 ,100% AR Medicaid ,$96.23 ,47% of billed charges or 100% of CAH Medicare ,$58.20 ,100% AR Medicaid ,$96.23 ,47% of billed charges or 100% of CAH Medicare ,$33.01 ,90% for custom fee schedule,$96.23 ,47% of billed charges or 100% of CAH Medicare ,$96.23 ,47% of billed charges or 100% of CAH Medicare ,$33.01 ,$120.29 ,$204.75 
Outpatient Medical Services,LAB,82105,Alpha-Fetoprotein Marker,301,$43.00 ,$25.26 ,58.75% of billed charges or 125% of CAH Medicare ,$25.26 ,58.75% of billed charges or 125% of CAH Medicare ,$20.82 ,48.41% of billed charges or 125% of CAH Medicare ,$20.50 ,100% of custom fee schedule,$20.50 ,100% of custom fee schedule,$20.21 ,47% of billed charges or 100% of CAH Medicare ,$20.50 ,100% of custom fee schedule,$25.26 ,58.75% of billed charges or 125% of CAH Medicare ,$17.96 ,100% AR Medicaid ,$20.21 ,47% of billed charges or 100% of CAH Medicare ,$23.95 ,100% AR Medicaid ,$20.21 ,47% of billed charges or 100% of CAH Medicare ,$13.58 ,90% for custom fee schedule,$20.21 ,47% of billed charges or 100% of CAH Medicare ,$20.21 ,47% of billed charges or 100% of CAH Medicare ,$13.58 ,$25.26 ,$43.00 
Outpatient Medical Services,LAB,82140,Ammonia,301,$40.00 ,$23.50 ,58.75% of billed charges or 125% of CAH Medicare ,$23.50 ,58.75% of billed charges or 125% of CAH Medicare ,$19.36 ,48.41% of billed charges or 125% of CAH Medicare ,$17.81 ,100% of custom fee schedule,$17.81 ,100% of custom fee schedule,$18.80 ,47% of billed charges or 100% of CAH Medicare ,$17.81 ,100% of custom fee schedule,$23.50 ,58.75% of billed charges or 125% of CAH Medicare ,$9.37 ,100% AR Medicaid ,$18.80 ,47% of billed charges or 100% of CAH Medicare ,$12.49 ,100% AR Medicaid ,$18.80 ,47% of billed charges or 100% of CAH Medicare ,$11.80 ,90% for custom fee schedule,$18.80 ,47% of billed charges or 100% of CAH Medicare ,$18.80 ,47% of billed charges or 100% of CAH Medicare ,$9.37 ,$23.50 ,$40.00 
Outpatient Medical Services,LAB,82150,Amylase,301,$79.00 ,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$38.24 ,48.41% of billed charges or 125% of CAH Medicare ,$7.92 ,100% of custom fee schedule,$7.92 ,100% of custom fee schedule,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$7.92 ,100% of custom fee schedule,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$6.95 ,100% AR Medicaid ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$9.26 ,100% AR Medicaid ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$5.25 ,90% for custom fee schedule,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$5.25 ,$46.41 ,$79.00 
Outpatient Medical Services,LAB,82164,Angiotensin-Converting Enzyme,301,$97.50 ,$57.28 ,58.75% of billed charges or 125% of CAH Medicare ,$57.28 ,58.75% of billed charges or 125% of CAH Medicare ,$47.20 ,48.41% of billed charges or 125% of CAH Medicare ,$17.84 ,100% of custom fee schedule,$17.84 ,100% of custom fee schedule,$45.83 ,47% of billed charges or 100% of CAH Medicare ,$17.84 ,100% of custom fee schedule,$57.28 ,58.75% of billed charges or 125% of CAH Medicare ,$15.63 ,100% AR Medicaid ,$45.83 ,47% of billed charges or 100% of CAH Medicare ,$20.84 ,100% AR Medicaid ,$45.83 ,47% of billed charges or 100% of CAH Medicare ,$11.83 ,90% for custom fee schedule,$45.83 ,47% of billed charges or 100% of CAH Medicare ,$45.83 ,47% of billed charges or 100% of CAH Medicare ,$11.83 ,$57.28 ,$97.50 
Outpatient Medical Services,LAB,82247,Bilirubin Total,301,$84.70 ,$49.76 ,58.75% of billed charges or 125% of CAH Medicare ,$49.76 ,58.75% of billed charges or 125% of CAH Medicare ,$41.00 ,48.41% of billed charges or 125% of CAH Medicare ,$6.13 ,100% of custom fee schedule,$6.13 ,100% of custom fee schedule,$39.81 ,47% of billed charges or 100% of CAH Medicare ,$6.13 ,100% of custom fee schedule,$49.76 ,58.75% of billed charges or 125% of CAH Medicare ,$5.38 ,100% AR Medicaid ,$39.81 ,47% of billed charges or 100% of CAH Medicare ,$7.17 ,100% AR Medicaid ,$39.81 ,47% of billed charges or 100% of CAH Medicare ,$4.07 ,90% for custom fee schedule,$39.81 ,47% of billed charges or 100% of CAH Medicare ,$39.81 ,47% of billed charges or 100% of CAH Medicare ,$4.07 ,$49.76 ,$84.70 
Outpatient Medical Services,LAB,82248,Bilirubin Direct,301,$94.00 ,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$45.51 ,48.41% of billed charges or 125% of CAH Medicare ,$6.13 ,100% of custom fee schedule,$6.13 ,100% of custom fee schedule,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$6.13 ,100% of custom fee schedule,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$5.38 ,100% AR Medicaid ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$7.17 ,100% AR Medicaid ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$4.07 ,90% for custom fee schedule,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$4.07 ,$55.23 ,$94.00 
Outpatient Medical Services,LAB,82270,Occult BL Feces 1-3,306,$49.00 ,$28.79 ,58.75% of billed charges or 125% of CAH Medicare ,$28.79 ,58.75% of billed charges or 125% of CAH Medicare ,$23.72 ,48.41% of billed charges or 125% of CAH Medicare ,$4.49 ,100% of custom fee schedule,$4.49 ,100% of custom fee schedule,$23.03 ,47% of billed charges or 100% of CAH Medicare ,$4.49 ,100% of custom fee schedule,$28.79 ,58.75% of billed charges or 125% of CAH Medicare ,$3.48 ,100% AR Medicaid ,$23.03 ,47% of billed charges or 100% of CAH Medicare ,$4.64 ,100% AR Medicaid ,$23.03 ,47% of billed charges or 100% of CAH Medicare ,$3.55 ,90% for custom fee schedule,$23.03 ,47% of billed charges or 100% of CAH Medicare ,$23.03 ,47% of billed charges or 100% of CAH Medicare ,$3.48 ,$28.79 ,$49.00 
Outpatient Medical Services,LAB,82306,Vitamin D,301,$142.00 ,$83.43 ,58.75% of billed charges or 125% of CAH Medicare ,$83.43 ,58.75% of billed charges or 125% of CAH Medicare ,$68.74 ,48.41% of billed charges or 125% of CAH Medicare ,$36.18 ,100% of custom fee schedule,$36.18 ,100% of custom fee schedule,$66.74 ,47% of billed charges or 100% of CAH Medicare ,$36.18 ,100% of custom fee schedule,$83.43 ,58.75% of billed charges or 125% of CAH Medicare ,$31.70 ,100% AR Medicaid ,$66.74 ,47% of billed charges or 100% of CAH Medicare ,$42.27 ,100% AR Medicaid ,$66.74 ,47% of billed charges or 100% of CAH Medicare ,$23.98 ,90% for custom fee schedule,$66.74 ,47% of billed charges or 100% of CAH Medicare ,$66.74 ,47% of billed charges or 100% of CAH Medicare ,$23.98 ,$83.43 ,$142.00 
Outpatient Medical Services,LAB,82310,Calcium,301,$120.00 ,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$58.09 ,48.41% of billed charges or 125% of CAH Medicare ,$6.30 ,100% of custom fee schedule,$6.30 ,100% of custom fee schedule,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$6.30 ,100% of custom fee schedule,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$5.52 ,100% AR Medicaid ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$7.36 ,100% AR Medicaid ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$4.18 ,90% for custom fee schedule,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$4.18 ,$70.50 ,$120.00 
Outpatient Medical Services,LAB,82378,CEA,300,$186.00 ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$90.04 ,48.41% of billed charges or 125% of CAH Medicare ,$23.18 ,100% of custom fee schedule,$23.18 ,100% of custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$23.18 ,100% of custom fee schedule,$109.28 ,58.75% of billed charges or 125% of CAH Medicare ,$20.32 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$27.09 ,100% AR Medicaid ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$15.35 ,90% for custom fee schedule,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$87.42 ,47% of billed charges or 100% of CAH Medicare ,$15.35 ,$109.28 ,$186.00 
Outpatient Medical Services,LAB,82465,Cholesterol,301,$147.00 ,$86.36 ,58.75% of billed charges or 125% of CAH Medicare ,$86.36 ,58.75% of billed charges or 125% of CAH Medicare ,$71.16 ,48.41% of billed charges or 125% of CAH Medicare ,$5.32 ,100% of custom fee schedule,$5.32 ,100% of custom fee schedule,$69.09 ,47% of billed charges or 100% of CAH Medicare ,$5.32 ,100% of custom fee schedule,$86.36 ,58.75% of billed charges or 125% of CAH Medicare ,$4.67 ,100% AR Medicaid ,$69.09 ,47% of billed charges or 100% of CAH Medicare ,$6.22 ,100% AR Medicaid ,$69.09 ,47% of billed charges or 100% of CAH Medicare ,$3.53 ,90% for custom fee schedule,$69.09 ,47% of billed charges or 100% of CAH Medicare ,$69.09 ,47% of billed charges or 100% of CAH Medicare ,$3.53 ,$86.36 ,$147.00 
Outpatient Medical Services,LAB,82533,Cortisol Level,301,$122.00 ,$71.68 ,58.75% of billed charges or 125% of CAH Medicare ,$71.68 ,58.75% of billed charges or 125% of CAH Medicare ,$59.06 ,48.41% of billed charges or 125% of CAH Medicare ,$19.92 ,100% of custom fee schedule,$19.92 ,100% of custom fee schedule,$57.34 ,47% of billed charges or 100% of CAH Medicare ,$19.92 ,100% of custom fee schedule,$71.68 ,58.75% of billed charges or 125% of CAH Medicare ,$17.46 ,100% AR Medicaid ,$57.34 ,47% of billed charges or 100% of CAH Medicare ,$23.28 ,100% AR Medicaid ,$57.34 ,47% of billed charges or 100% of CAH Medicare ,$13.20 ,90% for custom fee schedule,$57.34 ,47% of billed charges or 100% of CAH Medicare ,$57.34 ,47% of billed charges or 100% of CAH Medicare ,$13.20 ,$71.68 ,$122.00 
Outpatient Medical Services,LAB,82533,Cortisol AM,301,$100.80 ,$59.22 ,58.75% of billed charges or 125% of CAH Medicare ,$59.22 ,58.75% of billed charges or 125% of CAH Medicare ,$48.80 ,48.41% of billed charges or 125% of CAH Medicare ,$19.92 ,100% of custom fee schedule,$19.92 ,100% of custom fee schedule,$47.38 ,47% of billed charges or 100% of CAH Medicare ,$19.92 ,100% of custom fee schedule,$59.22 ,58.75% of billed charges or 125% of CAH Medicare ,$17.46 ,100% AR Medicaid ,$47.38 ,47% of billed charges or 100% of CAH Medicare ,$23.28 ,100% AR Medicaid ,$47.38 ,47% of billed charges or 100% of CAH Medicare ,$13.20 ,90% for custom fee schedule,$47.38 ,47% of billed charges or 100% of CAH Medicare ,$47.38 ,47% of billed charges or 100% of CAH Medicare ,$13.20 ,$59.22 ,$100.80 
Outpatient Medical Services,LAB,82550,CPK,301,$146.40 ,$86.01 ,58.75% of billed charges or 125% of CAH Medicare ,$86.01 ,58.75% of billed charges or 125% of CAH Medicare ,$70.87 ,48.41% of billed charges or 125% of CAH Medicare ,$7.95 ,100% of custom fee schedule,$7.95 ,100% of custom fee schedule,$68.81 ,47% of billed charges or 100% of CAH Medicare ,$7.95 ,100% of custom fee schedule,$86.01 ,58.75% of billed charges or 125% of CAH Medicare ,$6.98 ,100% AR Medicaid ,$68.81 ,47% of billed charges or 100% of CAH Medicare ,$9.31 ,100% AR Medicaid ,$68.81 ,47% of billed charges or 100% of CAH Medicare ,$5.27 ,90% for custom fee schedule,$68.81 ,47% of billed charges or 100% of CAH Medicare ,$68.81 ,47% of billed charges or 100% of CAH Medicare ,$5.27 ,$86.01 ,$146.40 
Outpatient Medical Services,LAB,82553,"CKMB (CE, Cardiac Enzymes)",301,$162.40 ,$95.41 ,58.75% of billed charges or 125% of CAH Medicare ,$95.41 ,58.75% of billed charges or 125% of CAH Medicare ,$78.62 ,48.41% of billed charges or 125% of CAH Medicare ,$14.11 ,100% of custom fee schedule,$14.11 ,100% of custom fee schedule,$76.33 ,47% of billed charges or 100% of CAH Medicare ,$14.11 ,100% of custom fee schedule,$95.41 ,58.75% of billed charges or 125% of CAH Medicare ,$12.36 ,100% AR Medicaid ,$76.33 ,47% of billed charges or 100% of CAH Medicare ,$16.48 ,100% AR Medicaid ,$76.33 ,47% of billed charges or 100% of CAH Medicare ,$9.36 ,90% for custom fee schedule,$76.33 ,47% of billed charges or 100% of CAH Medicare ,$76.33 ,47% of billed charges or 100% of CAH Medicare ,$9.36 ,$95.41 ,$162.40 
Outpatient Medical Services,CT,82565,Creatinine,301,$85.91 ,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$41.59 ,48.41% of billed charges or 125% of CAH Medicare ,$6.26 ,100% of custom fee schedule,$6.26 ,100% of custom fee schedule,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$6.26 ,100% of custom fee schedule,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$5.48 ,100% AR Medicaid ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$7.31 ,100% AR Medicaid ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$4.15 ,90% for custom fee schedule,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$4.15 ,$50.47 ,$85.91 
Outpatient Medical Services,LAB,82565,Creatinine,301,$85.91 ,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$41.59 ,48.41% of billed charges or 125% of CAH Medicare ,$6.26 ,100% of custom fee schedule,$6.26 ,100% of custom fee schedule,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$6.26 ,100% of custom fee schedule,$50.47 ,58.75% of billed charges or 125% of CAH Medicare ,$5.48 ,100% AR Medicaid ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$7.31 ,100% AR Medicaid ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$4.15 ,90% for custom fee schedule,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$40.38 ,47% of billed charges or 100% of CAH Medicare ,$4.15 ,$50.47 ,$85.91 
Outpatient Medical Services,LAB,82570,Protein/Creatinine Urine Random,301,$11.84 ,$6.96 ,58.75% of billed charges or 125% of CAH Medicare ,$6.96 ,58.75% of billed charges or 125% of CAH Medicare ,$5.73 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$5.56 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.96 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$5.56 ,47% of billed charges or 100% of CAH Medicare ,$7.39 ,100% AR Medicaid ,$5.56 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$5.56 ,47% of billed charges or 100% of CAH Medicare ,$5.56 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$7.39 ,$11.84 
Outpatient Medical Services,LAB,82570,Creatine Urine,307,$37.00 ,$21.74 ,58.75% of billed charges or 125% of CAH Medicare ,$21.74 ,58.75% of billed charges or 125% of CAH Medicare ,$17.91 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$17.39 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$21.74 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$17.39 ,47% of billed charges or 100% of CAH Medicare ,$7.39 ,100% AR Medicaid ,$17.39 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$17.39 ,47% of billed charges or 100% of CAH Medicare ,$17.39 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$21.74 ,$37.00 
Outpatient Medical Services,LAB,82575,Creatine Clear,307,$113.00 ,$66.39 ,58.75% of billed charges or 125% of CAH Medicare ,$66.39 ,58.75% of billed charges or 125% of CAH Medicare ,$54.70 ,48.41% of billed charges or 125% of CAH Medicare ,$11.56 ,100% of custom fee schedule,$11.56 ,100% of custom fee schedule,$53.11 ,47% of billed charges or 100% of CAH Medicare ,$11.56 ,100% of custom fee schedule,$66.39 ,58.75% of billed charges or 125% of CAH Medicare ,$10.13 ,100% AR Medicaid ,$53.11 ,47% of billed charges or 100% of CAH Medicare ,$13.50 ,100% AR Medicaid ,$53.11 ,47% of billed charges or 100% of CAH Medicare ,$7.66 ,90% for custom fee schedule,$53.11 ,47% of billed charges or 100% of CAH Medicare ,$53.11 ,47% of billed charges or 100% of CAH Medicare ,$7.66 ,$66.39 ,$113.00 
Outpatient Medical Services,LAB,82607,Vitamin B-12,301,$151.75 ,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$73.46 ,48.41% of billed charges or 125% of CAH Medicare ,$18.43 ,100% of custom fee schedule,$18.43 ,100% of custom fee schedule,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$18.43 ,100% of custom fee schedule,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$16.14 ,100% AR Medicaid ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$21.52 ,100% AR Medicaid ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$12.21 ,90% for custom fee schedule,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$12.21 ,$89.15 ,$151.75 
Outpatient Medical Services,LAB,82670,Estradiol,301,$60.09 ,$35.30 ,58.75% of billed charges or 125% of CAH Medicare ,$35.30 ,58.75% of billed charges or 125% of CAH Medicare ,$29.09 ,48.41% of billed charges or 125% of CAH Medicare ,$34.14 ,100% of custom fee schedule,$34.14 ,100% of custom fee schedule,$28.24 ,47% of billed charges or 100% of CAH Medicare ,$34.14 ,100% of custom fee schedule,$35.30 ,58.75% of billed charges or 125% of CAH Medicare ,$29.93 ,100% AR Medicaid ,$28.24 ,47% of billed charges or 100% of CAH Medicare ,$39.91 ,100% AR Medicaid ,$28.24 ,47% of billed charges or 100% of CAH Medicare ,$22.64 ,90% for custom fee schedule,$28.24 ,47% of billed charges or 100% of CAH Medicare ,$28.24 ,47% of billed charges or 100% of CAH Medicare ,$22.64 ,$39.91 ,$60.09 
Outpatient Medical Services,LAB,82672,Estrogen,301,$332.00 ,$195.05 ,58.75% of billed charges or 125% of CAH Medicare ,$195.05 ,58.75% of billed charges or 125% of CAH Medicare ,$160.72 ,48.41% of billed charges or 125% of CAH Medicare ,$26.52 ,100% of custom fee schedule,$26.52 ,100% of custom fee schedule,$156.04 ,47% of billed charges or 100% of CAH Medicare ,$26.52 ,100% of custom fee schedule,$195.05 ,58.75% of billed charges or 125% of CAH Medicare ,$23.23 ,100% AR Medicaid ,$156.04 ,47% of billed charges or 100% of CAH Medicare ,$30.97 ,100% AR Medicaid ,$156.04 ,47% of billed charges or 100% of CAH Medicare ,$17.58 ,90% for custom fee schedule,$156.04 ,47% of billed charges or 100% of CAH Medicare ,$156.04 ,47% of billed charges or 100% of CAH Medicare ,$17.58 ,$195.05 ,$332.00 
Outpatient Medical Services,LAB,82728,Ferritin,300,$134.00 ,$78.73 ,58.75% of billed charges or 125% of CAH Medicare ,$78.73 ,58.75% of billed charges or 125% of CAH Medicare ,$64.87 ,48.41% of billed charges or 125% of CAH Medicare ,$16.67 ,100% of custom fee schedule,$16.67 ,100% of custom fee schedule,$62.98 ,47% of billed charges or 100% of CAH Medicare ,$16.67 ,100% of custom fee schedule,$78.73 ,58.75% of billed charges or 125% of CAH Medicare ,$14.60 ,100% AR Medicaid ,$62.98 ,47% of billed charges or 100% of CAH Medicare ,$19.46 ,100% AR Medicaid ,$62.98 ,47% of billed charges or 100% of CAH Medicare ,$11.04 ,90% for custom fee schedule,$62.98 ,47% of billed charges or 100% of CAH Medicare ,$62.98 ,47% of billed charges or 100% of CAH Medicare ,$11.04 ,$78.73 ,$134.00 
Outpatient Medical Services,LAB,82746,Folate Serum,300,$143.75 ,$84.45 ,58.75% of billed charges or 125% of CAH Medicare ,$84.45 ,58.75% of billed charges or 125% of CAH Medicare ,$69.59 ,48.41% of billed charges or 125% of CAH Medicare ,$17.97 ,100% of custom fee schedule,$17.97 ,100% of custom fee schedule,$67.56 ,47% of billed charges or 100% of CAH Medicare ,$17.97 ,100% of custom fee schedule,$84.45 ,58.75% of billed charges or 125% of CAH Medicare ,$15.75 ,100% AR Medicaid ,$67.56 ,47% of billed charges or 100% of CAH Medicare ,$21.00 ,100% AR Medicaid ,$67.56 ,47% of billed charges or 100% of CAH Medicare ,$11.91 ,90% for custom fee schedule,$67.56 ,47% of billed charges or 100% of CAH Medicare ,$67.56 ,47% of billed charges or 100% of CAH Medicare ,$11.91 ,$84.45 ,$143.75 
Outpatient Medical Services,Respiratory Therapy,82803,Arterial Blood Gases,300,$219.95 ,$129.22 ,58.75% of billed charges or 125% of CAH Medicare ,$129.22 ,58.75% of billed charges or 125% of CAH Medicare ,$106.48 ,48.41% of billed charges or 125% of CAH Medicare ,$26.72 ,100% of custom fee schedule,$26.72 ,100% of custom fee schedule,$103.38 ,47% of billed charges or 100% of CAH Medicare ,$26.72 ,100% of custom fee schedule,$129.22 ,58.75% of billed charges or 125% of CAH Medicare ,$20.72 ,100% AR Medicaid ,$103.38 ,47% of billed charges or 100% of CAH Medicare ,$27.63 ,100% AR Medicaid ,$103.38 ,47% of billed charges or 100% of CAH Medicare ,$21.11 ,90% for custom fee schedule,$103.38 ,47% of billed charges or 100% of CAH Medicare ,$103.38 ,47% of billed charges or 100% of CAH Medicare ,$20.72 ,$129.22 ,$219.95 
Outpatient Medical Services,LAB,82947,Glucose Blood Sugar,301,$150.45 ,$88.39 ,58.75% of billed charges or 125% of CAH Medicare ,$88.39 ,58.75% of billed charges or 125% of CAH Medicare ,$72.83 ,48.41% of billed charges or 125% of CAH Medicare ,$4.81 ,100% of custom fee schedule,$4.81 ,100% of custom fee schedule,$70.71 ,47% of billed charges or 100% of CAH Medicare ,$4.81 ,100% of custom fee schedule,$88.39 ,58.75% of billed charges or 125% of CAH Medicare ,$4.20 ,100% AR Medicaid ,$70.71 ,47% of billed charges or 100% of CAH Medicare ,$5.60 ,100% AR Medicaid ,$70.71 ,47% of billed charges or 100% of CAH Medicare ,$3.19 ,90% for custom fee schedule,$70.71 ,47% of billed charges or 100% of CAH Medicare ,$70.71 ,47% of billed charges or 100% of CAH Medicare ,$3.19 ,$88.39 ,$150.45 
Outpatient Medical Services,LAB,82951,Glucose Tol 3 hour,301,$128.00 ,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$61.96 ,48.41% of billed charges or 125% of CAH Medicare ,$15.73 ,100% of custom fee schedule,$15.73 ,100% of custom fee schedule,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$15.73 ,100% of custom fee schedule,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$13.79 ,100% AR Medicaid ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$18.39 ,100% AR Medicaid ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$10.42 ,90% for custom fee schedule,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$10.42 ,$75.20 ,$128.00 
Outpatient Medical Services,LAB,82977,Gamma Gluta Tran GGT,301,$181.00 ,$106.34 ,58.75% of billed charges or 125% of CAH Medicare ,$106.34 ,58.75% of billed charges or 125% of CAH Medicare ,$87.62 ,48.41% of billed charges or 125% of CAH Medicare ,$8.80 ,100% of custom fee schedule,$8.80 ,100% of custom fee schedule,$85.07 ,47% of billed charges or 100% of CAH Medicare ,$8.80 ,100% of custom fee schedule,$106.34 ,58.75% of billed charges or 125% of CAH Medicare ,$7.71 ,100% AR Medicaid ,$85.07 ,47% of billed charges or 100% of CAH Medicare ,$10.28 ,100% AR Medicaid ,$85.07 ,47% of billed charges or 100% of CAH Medicare ,$5.83 ,90% for custom fee schedule,$85.07 ,47% of billed charges or 100% of CAH Medicare ,$85.07 ,47% of billed charges or 100% of CAH Medicare ,$5.83 ,$106.34 ,$181.00 
Outpatient Medical Services,LAB,83002,Luteinizing Hormone,300,$96.00 ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$46.47 ,48.41% of billed charges or 125% of CAH Medicare ,$22.63 ,100% of custom fee schedule,$22.63 ,100% of custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$22.63 ,100% of custom fee schedule,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$19.84 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$26.45 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$15.00 ,90% for custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$15.00 ,$56.40 ,$96.00 
Outpatient Medical Services,LAB,83020,Hemogl Electrophores,305,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$15.73 ,100% of custom fee schedule,$15.73 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$15.73 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$13.79 ,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$18.39 ,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$10.42 ,90% for custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$10.42 ,$76.38 ,$130.00 
Outpatient Medical Services,LAB,83036,HGB A1C,301,$128.85 ,$75.70 ,58.75% of billed charges or 125% of CAH Medicare ,$75.70 ,58.75% of billed charges or 125% of CAH Medicare ,$62.38 ,48.41% of billed charges or 125% of CAH Medicare ,$11.87 ,100% of custom fee schedule,$11.87 ,100% of custom fee schedule,$60.56 ,47% of billed charges or 100% of CAH Medicare ,$11.87 ,100% of custom fee schedule,$75.70 ,58.75% of billed charges or 125% of CAH Medicare ,$10.40 ,100% AR Medicaid ,$60.56 ,47% of billed charges or 100% of CAH Medicare ,$13.87 ,100% AR Medicaid ,$60.56 ,47% of billed charges or 100% of CAH Medicare ,$7.87 ,90% for custom fee schedule,$60.56 ,47% of billed charges or 100% of CAH Medicare ,$60.56 ,47% of billed charges or 100% of CAH Medicare ,$7.87 ,$75.70 ,$128.85 
Outpatient Medical Services,LAB,83525,Insulin,301,$80.00 ,$47.00 ,58.75% of billed charges or 125% of CAH Medicare ,$47.00 ,58.75% of billed charges or 125% of CAH Medicare ,$38.73 ,48.41% of billed charges or 125% of CAH Medicare ,$13.97 ,100% of custom fee schedule,$13.97 ,100% of custom fee schedule,$37.60 ,47% of billed charges or 100% of CAH Medicare ,$13.97 ,100% of custom fee schedule,$47.00 ,58.75% of billed charges or 125% of CAH Medicare ,$12.26 ,100% AR Medicaid ,$37.60 ,47% of billed charges or 100% of CAH Medicare ,$16.34 ,100% AR Medicaid ,$37.60 ,47% of billed charges or 100% of CAH Medicare ,$9.26 ,90% for custom fee schedule,$37.60 ,47% of billed charges or 100% of CAH Medicare ,$37.60 ,47% of billed charges or 100% of CAH Medicare ,$9.26 ,$47.00 ,$80.00 
Outpatient Medical Services,LAB,83540,Iron Serum,301,$105.45 ,$61.95 ,58.75% of billed charges or 125% of CAH Medicare ,$61.95 ,58.75% of billed charges or 125% of CAH Medicare ,$51.05 ,48.41% of billed charges or 125% of CAH Medicare ,$7.91 ,100% of custom fee schedule,$7.91 ,100% of custom fee schedule,$49.56 ,47% of billed charges or 100% of CAH Medicare ,$7.91 ,100% of custom fee schedule,$61.95 ,58.75% of billed charges or 125% of CAH Medicare ,$6.94 ,100% AR Medicaid ,$49.56 ,47% of billed charges or 100% of CAH Medicare ,$9.25 ,100% AR Medicaid ,$49.56 ,47% of billed charges or 100% of CAH Medicare ,$5.24 ,90% for custom fee schedule,$49.56 ,47% of billed charges or 100% of CAH Medicare ,$49.56 ,47% of billed charges or 100% of CAH Medicare ,$5.24 ,$61.95 ,$105.45 
Outpatient Medical Services,LAB,83550,Iron Binding Capacity,301,$95.85 ,$56.31 ,58.75% of billed charges or 125% of CAH Medicare ,$56.31 ,58.75% of billed charges or 125% of CAH Medicare ,$46.40 ,48.41% of billed charges or 125% of CAH Medicare ,$10.68 ,100% of custom fee schedule,$10.68 ,100% of custom fee schedule,$45.05 ,47% of billed charges or 100% of CAH Medicare ,$10.68 ,100% of custom fee schedule,$56.31 ,58.75% of billed charges or 125% of CAH Medicare ,$9.36 ,100% AR Medicaid ,$45.05 ,47% of billed charges or 100% of CAH Medicare ,$12.48 ,100% AR Medicaid ,$45.05 ,47% of billed charges or 100% of CAH Medicare ,$7.08 ,90% for custom fee schedule,$45.05 ,47% of billed charges or 100% of CAH Medicare ,$45.05 ,47% of billed charges or 100% of CAH Medicare ,$7.08 ,$56.31 ,$95.85 
Outpatient Medical Services,LAB,83605,Lactic Acid,301,$111.30 ,$65.39 ,58.75% of billed charges or 125% of CAH Medicare ,$65.39 ,58.75% of billed charges or 125% of CAH Medicare ,$53.88 ,48.41% of billed charges or 125% of CAH Medicare ,$13.06 ,100% of custom fee schedule,$13.06 ,100% of custom fee schedule,$52.31 ,47% of billed charges or 100% of CAH Medicare ,$13.06 ,100% of custom fee schedule,$65.39 ,58.75% of billed charges or 125% of CAH Medicare ,$11.44 ,100% AR Medicaid ,$52.31 ,47% of billed charges or 100% of CAH Medicare ,$15.25 ,100% AR Medicaid ,$52.31 ,47% of billed charges or 100% of CAH Medicare ,$9.37 ,90% for custom fee schedule,$52.31 ,47% of billed charges or 100% of CAH Medicare ,$52.31 ,47% of billed charges or 100% of CAH Medicare ,$9.37 ,$65.39 ,$111.30 
Outpatient Medical Services,LAB,83615,LDH Lactate Dehydrog,301,$135.00 ,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$65.35 ,48.41% of billed charges or 125% of CAH Medicare ,$7.38 ,100% of custom fee schedule,$7.38 ,100% of custom fee schedule,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$7.38 ,100% of custom fee schedule,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$6.47 ,100% AR Medicaid ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$8.63 ,100% AR Medicaid ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$4.90 ,90% for custom fee schedule,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$4.90 ,$79.31 ,$135.00 
Outpatient Medical Services,LAB,83655,Lead Quant Series,300,$186.35 ,$109.48 ,58.75% of billed charges or 125% of CAH Medicare ,$109.48 ,58.75% of billed charges or 125% of CAH Medicare ,$90.21 ,48.41% of billed charges or 125% of CAH Medicare ,$14.80 ,100% of custom fee schedule,$14.80 ,100% of custom fee schedule,$87.58 ,47% of billed charges or 100% of CAH Medicare ,$14.80 ,100% of custom fee schedule,$109.48 ,58.75% of billed charges or 125% of CAH Medicare ,$12.96 ,100% AR Medicaid ,$87.58 ,47% of billed charges or 100% of CAH Medicare ,$17.28 ,100% AR Medicaid ,$87.58 ,47% of billed charges or 100% of CAH Medicare ,$9.81 ,90% for custom fee schedule,$87.58 ,47% of billed charges or 100% of CAH Medicare ,$87.58 ,47% of billed charges or 100% of CAH Medicare ,$9.81 ,$109.48 ,$186.35 
Outpatient Medical Services,LAB,83690,Lipase,301,$78.10 ,$45.88 ,58.75% of billed charges or 125% of CAH Medicare ,$45.88 ,58.75% of billed charges or 125% of CAH Medicare ,$37.81 ,48.41% of billed charges or 125% of CAH Medicare ,$8.42 ,100% of custom fee schedule,$8.42 ,100% of custom fee schedule,$36.71 ,47% of billed charges or 100% of CAH Medicare ,$8.42 ,100% of custom fee schedule,$45.88 ,58.75% of billed charges or 125% of CAH Medicare ,$7.38 ,100% AR Medicaid ,$36.71 ,47% of billed charges or 100% of CAH Medicare ,$9.84 ,100% AR Medicaid ,$36.71 ,47% of billed charges or 100% of CAH Medicare ,$5.58 ,90% for custom fee schedule,$36.71 ,47% of billed charges or 100% of CAH Medicare ,$36.71 ,47% of billed charges or 100% of CAH Medicare ,$5.58 ,$45.88 ,$78.10 
Outpatient Medical Services,LAB,83721,LDL Cholesteron (Direct),301,$29.81 ,$17.51 ,58.75% of billed charges or 125% of CAH Medicare ,$17.51 ,58.75% of billed charges or 125% of CAH Medicare ,$14.43 ,48.41% of billed charges or 125% of CAH Medicare ,$11.66 ,100% of custom fee schedule,$11.66 ,100% of custom fee schedule,$14.01 ,47% of billed charges or 100% of CAH Medicare ,$11.66 ,100% of custom fee schedule,$17.51 ,58.75% of billed charges or 125% of CAH Medicare ,$10.22 ,100% AR Medicaid ,$14.01 ,47% of billed charges or 100% of CAH Medicare ,$13.62 ,100% AR Medicaid ,$14.01 ,47% of billed charges or 100% of CAH Medicare ,$8.51 ,90% for custom fee schedule,$14.01 ,47% of billed charges or 100% of CAH Medicare ,$14.01 ,47% of billed charges or 100% of CAH Medicare ,$8.51 ,$17.51 ,$29.81 
Outpatient Medical Services,LAB,83735,Magnesium (MG),301,$93.70 ,$55.05 ,58.75% of billed charges or 125% of CAH Medicare ,$55.05 ,58.75% of billed charges or 125% of CAH Medicare ,$45.36 ,48.41% of billed charges or 125% of CAH Medicare ,$8.18 ,100% of custom fee schedule,$8.18 ,100% of custom fee schedule,$44.04 ,47% of billed charges or 100% of CAH Medicare ,$8.18 ,100% of custom fee schedule,$55.05 ,58.75% of billed charges or 125% of CAH Medicare ,$7.18 ,100% AR Medicaid ,$44.04 ,47% of billed charges or 100% of CAH Medicare ,$9.57 ,100% AR Medicaid ,$44.04 ,47% of billed charges or 100% of CAH Medicare ,$5.43 ,90% for custom fee schedule,$44.04 ,47% of billed charges or 100% of CAH Medicare ,$44.04 ,47% of billed charges or 100% of CAH Medicare ,$5.43 ,$55.05 ,$93.70 
Outpatient Medical Services,LAB,83880,BNP,301,$391.00 ,$229.71 ,58.75% of billed charges or 125% of CAH Medicare ,$229.71 ,58.75% of billed charges or 125% of CAH Medicare ,$189.28 ,48.41% of billed charges or 125% of CAH Medicare ,$42.95 ,100% of custom fee schedule,$42.95 ,100% of custom fee schedule,$183.77 ,47% of billed charges or 100% of CAH Medicare ,$42.95 ,100% of custom fee schedule,$229.71 ,58.75% of billed charges or 125% of CAH Medicare ,$35.57 ,100% AR Medicaid ,$183.77 ,47% of billed charges or 100% of CAH Medicare ,$47.43 ,100% AR Medicaid ,$183.77 ,47% of billed charges or 100% of CAH Medicare ,$31.80 ,90% for custom fee schedule,$183.77 ,47% of billed charges or 100% of CAH Medicare ,$183.77 ,47% of billed charges or 100% of CAH Medicare ,$31.80 ,$229.71 ,$391.00 
Outpatient Medical Services,LAB,83930,Osmolality,300,$114.00 ,$66.98 ,58.75% of billed charges or 125% of CAH Medicare ,$66.98 ,58.75% of billed charges or 125% of CAH Medicare ,$55.19 ,48.41% of billed charges or 125% of CAH Medicare ,$8.09 ,100% of custom fee schedule,$8.09 ,100% of custom fee schedule,$53.58 ,47% of billed charges or 100% of CAH Medicare ,$8.09 ,100% of custom fee schedule,$66.98 ,58.75% of billed charges or 125% of CAH Medicare ,$7.07 ,100% AR Medicaid ,$53.58 ,47% of billed charges or 100% of CAH Medicare ,$9.43 ,100% AR Medicaid ,$53.58 ,47% of billed charges or 100% of CAH Medicare ,$5.36 ,90% for custom fee schedule,$53.58 ,47% of billed charges or 100% of CAH Medicare ,$53.58 ,47% of billed charges or 100% of CAH Medicare ,$5.36 ,$66.98 ,$114.00 
Outpatient Medical Services,LAB,84075,Phosphatese Alkaline,301,$79.00 ,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$38.24 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$46.41 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$7.39 ,100% AR Medicaid ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$37.13 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$46.41 ,$79.00 
Outpatient Medical Services,LAB,84100,Phrosphorus Serum,301,$137.00 ,$80.49 ,58.75% of billed charges or 125% of CAH Medicare ,$80.49 ,58.75% of billed charges or 125% of CAH Medicare ,$66.32 ,48.41% of billed charges or 125% of CAH Medicare ,$5.80 ,100% of custom fee schedule,$5.80 ,100% of custom fee schedule,$64.39 ,47% of billed charges or 100% of CAH Medicare ,$5.80 ,100% of custom fee schedule,$80.49 ,58.75% of billed charges or 125% of CAH Medicare ,$5.09 ,100% AR Medicaid ,$64.39 ,47% of billed charges or 100% of CAH Medicare ,$6.78 ,100% AR Medicaid ,$64.39 ,47% of billed charges or 100% of CAH Medicare ,$3.84 ,90% for custom fee schedule,$64.39 ,47% of billed charges or 100% of CAH Medicare ,$64.39 ,47% of billed charges or 100% of CAH Medicare ,$3.84 ,$80.49 ,$137.00 
Outpatient Medical Services,LAB,84132,Potassium,301,$203.00 ,$119.26 ,58.75% of billed charges or 125% of CAH Medicare ,$119.26 ,58.75% of billed charges or 125% of CAH Medicare ,$98.27 ,48.41% of billed charges or 125% of CAH Medicare ,$5.62 ,100% of custom fee schedule,$5.62 ,100% of custom fee schedule,$95.41 ,47% of billed charges or 100% of CAH Medicare ,$5.62 ,100% of custom fee schedule,$119.26 ,58.75% of billed charges or 125% of CAH Medicare ,$4.92 ,100% AR Medicaid ,$95.41 ,47% of billed charges or 100% of CAH Medicare ,$6.56 ,100% AR Medicaid ,$95.41 ,47% of billed charges or 100% of CAH Medicare ,$3.85 ,90% for custom fee schedule,$95.41 ,47% of billed charges or 100% of CAH Medicare ,$95.41 ,47% of billed charges or 100% of CAH Medicare ,$3.85 ,$119.26 ,$203.00 
Outpatient Medical Services,LAB,84134,Prealbumin,301,$129.00 ,$75.79 ,58.75% of billed charges or 125% of CAH Medicare ,$75.79 ,58.75% of billed charges or 125% of CAH Medicare ,$62.45 ,48.41% of billed charges or 125% of CAH Medicare ,$17.83 ,100% of custom fee schedule,$17.83 ,100% of custom fee schedule,$60.63 ,47% of billed charges or 100% of CAH Medicare ,$17.83 ,100% of custom fee schedule,$75.79 ,58.75% of billed charges or 125% of CAH Medicare ,$15.62 ,100% AR Medicaid ,$60.63 ,47% of billed charges or 100% of CAH Medicare ,$20.83 ,100% AR Medicaid ,$60.63 ,47% of billed charges or 100% of CAH Medicare ,$11.82 ,90% for custom fee schedule,$60.63 ,47% of billed charges or 100% of CAH Medicare ,$60.63 ,47% of billed charges or 100% of CAH Medicare ,$11.82 ,$75.79 ,$129.00 
Outpatient Medical Services,LAB,84144,Progesterone,301,$100.00 ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$48.41 ,48.41% of billed charges or 125% of CAH Medicare ,$25.50 ,100% of custom fee schedule,$25.50 ,100% of custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$25.50 ,100% of custom fee schedule,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$22.34 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$29.79 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$16.89 ,90% for custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$16.89 ,$58.75 ,$100.00 
Outpatient Medical Services,LAB,84146,Prolactin,301,$50.08 ,$29.42 ,58.75% of billed charges or 125% of CAH Medicare ,$29.42 ,58.75% of billed charges or 125% of CAH Medicare ,$24.24 ,48.41% of billed charges or 125% of CAH Medicare ,$23.68 ,100% of custom fee schedule,$23.68 ,100% of custom fee schedule,$23.54 ,47% of billed charges or 100% of CAH Medicare ,$23.68 ,100% of custom fee schedule,$29.42 ,58.75% of billed charges or 125% of CAH Medicare ,$20.75 ,100% AR Medicaid ,$23.54 ,47% of billed charges or 100% of CAH Medicare ,$27.67 ,100% AR Medicaid ,$23.54 ,47% of billed charges or 100% of CAH Medicare ,$15.70 ,90% for custom fee schedule,$23.54 ,47% of billed charges or 100% of CAH Medicare ,$23.54 ,47% of billed charges or 100% of CAH Medicare ,$15.70 ,$29.42 ,$50.08 
Outpatient Medical Services,LAB,84153,PSA (Prostate Specific Antigen)     *,301,$163.35 ,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,$79.08 ,48.41% of billed charges or 125% of CAH Medicare ,$22.48 ,100% of custom fee schedule,$22.48 ,100% of custom fee schedule,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$22.48 ,100% of custom fee schedule,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,$19.70 ,100% AR Medicaid ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$26.27 ,100% AR Medicaid ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$14.90 ,90% for custom fee schedule,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$14.90 ,$95.97 ,$163.35 
Outpatient Medical Services,LAB,84155,Protein Total,301,$78.00 ,$45.83 ,58.75% of billed charges or 125% of CAH Medicare ,$45.83 ,58.75% of billed charges or 125% of CAH Medicare ,$37.76 ,48.41% of billed charges or 125% of CAH Medicare ,$4.48 ,100% of custom fee schedule,$4.48 ,100% of custom fee schedule,$36.66 ,47% of billed charges or 100% of CAH Medicare ,$4.48 ,100% of custom fee schedule,$45.83 ,58.75% of billed charges or 125% of CAH Medicare ,$3.92 ,100% AR Medicaid ,$36.66 ,47% of billed charges or 100% of CAH Medicare ,$5.23 ,100% AR Medicaid ,$36.66 ,47% of billed charges or 100% of CAH Medicare ,$2.97 ,90% for custom fee schedule,$36.66 ,47% of billed charges or 100% of CAH Medicare ,$36.66 ,47% of billed charges or 100% of CAH Medicare ,$2.97 ,$45.83 ,$78.00 
Outpatient Medical Services,LAB,84156,Protein Urine Qt 24 HR,301,$64.00 ,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$30.98 ,48.41% of billed charges or 125% of CAH Medicare ,$4.48 ,100% of custom fee schedule,$4.48 ,100% of custom fee schedule,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$4.48 ,100% of custom fee schedule,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$3.94 ,100% AR Medicaid ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$5.25 ,100% AR Medicaid ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$2.97 ,90% for custom fee schedule,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$2.97 ,$37.60 ,$64.00 
Outpatient Medical Services,LAB,84165,Protein Electrophoresis,300,$106.00 ,$62.28 ,58.75% of billed charges or 125% of CAH Medicare ,$62.28 ,58.75% of billed charges or 125% of CAH Medicare ,$51.31 ,48.41% of billed charges or 125% of CAH Medicare ,$13.12 ,100% of custom fee schedule,$13.12 ,100% of custom fee schedule,$49.82 ,47% of billed charges or 100% of CAH Medicare ,$13.12 ,100% of custom fee schedule,$62.28 ,58.75% of billed charges or 125% of CAH Medicare ,$11.50 ,100% AR Medicaid ,$49.82 ,47% of billed charges or 100% of CAH Medicare ,$15.33 ,100% AR Medicaid ,$49.82 ,47% of billed charges or 100% of CAH Medicare ,$8.70 ,90% for custom fee schedule,$49.82 ,47% of billed charges or 100% of CAH Medicare ,$49.82 ,47% of billed charges or 100% of CAH Medicare ,$8.70 ,$62.28 ,$106.00 
Outpatient Medical Services,LAB,84166,"Protein, Electrophoresis Urine",301,$193.00 ,$113.39 ,58.75% of billed charges or 125% of CAH Medicare ,$113.39 ,58.75% of billed charges or 125% of CAH Medicare ,$93.43 ,48.41% of billed charges or 125% of CAH Medicare ,$21.79 ,100% of custom fee schedule,$21.79 ,100% of custom fee schedule,$90.71 ,47% of billed charges or 100% of CAH Medicare ,$21.79 ,100% of custom fee schedule,$113.39 ,58.75% of billed charges or 125% of CAH Medicare ,$20.81 ,100% AR Medicaid ,$90.71 ,47% of billed charges or 100% of CAH Medicare ,$27.75 ,100% AR Medicaid ,$90.71 ,47% of billed charges or 100% of CAH Medicare ,$14.45 ,90% for custom fee schedule,$90.71 ,47% of billed charges or 100% of CAH Medicare ,$90.71 ,47% of billed charges or 100% of CAH Medicare ,$14.45 ,$113.39 ,$193.00 
Outpatient Medical Services,LAB,84295,Sodium,301,$94.00 ,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$45.51 ,48.41% of billed charges or 125% of CAH Medicare ,$5.89 ,100% of custom fee schedule,$5.89 ,100% of custom fee schedule,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$5.89 ,100% of custom fee schedule,$55.23 ,58.75% of billed charges or 125% of CAH Medicare ,$5.15 ,100% AR Medicaid ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$6.87 ,100% AR Medicaid ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$3.90 ,90% for custom fee schedule,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$44.18 ,47% of billed charges or 100% of CAH Medicare ,$3.90 ,$55.23 ,$94.00 
Outpatient Medical Services,LAB,84300,Sodium 24 Hr Urine,307,$72.60 ,$42.65 ,58.75% of billed charges or 125% of CAH Medicare ,$42.65 ,58.75% of billed charges or 125% of CAH Medicare ,$35.15 ,48.41% of billed charges or 125% of CAH Medicare ,$5.94 ,100% of custom fee schedule,$5.94 ,100% of custom fee schedule,$34.12 ,47% of billed charges or 100% of CAH Medicare ,$5.94 ,100% of custom fee schedule,$42.65 ,58.75% of billed charges or 125% of CAH Medicare ,$5.21 ,100% AR Medicaid ,$34.12 ,47% of billed charges or 100% of CAH Medicare ,$6.94 ,100% AR Medicaid ,$34.12 ,47% of billed charges or 100% of CAH Medicare ,$4.10 ,90% for custom fee schedule,$34.12 ,47% of billed charges or 100% of CAH Medicare ,$34.12 ,47% of billed charges or 100% of CAH Medicare ,$4.10 ,$42.65 ,$72.60 
Outpatient Medical Services,LAB,84402,Free Testosterone,301,$125.40 ,$73.67 ,58.75% of billed charges or 125% of CAH Medicare ,$73.67 ,58.75% of billed charges or 125% of CAH Medicare ,$60.71 ,48.41% of billed charges or 125% of CAH Medicare ,$31.13 ,100% of custom fee schedule,$31.13 ,100% of custom fee schedule,$58.94 ,47% of billed charges or 100% of CAH Medicare ,$31.13 ,100% of custom fee schedule,$73.67 ,58.75% of billed charges or 125% of CAH Medicare ,$27.27 ,100% AR Medicaid ,$58.94 ,47% of billed charges or 100% of CAH Medicare ,$36.36 ,100% AR Medicaid ,$58.94 ,47% of billed charges or 100% of CAH Medicare ,$20.63 ,90% for custom fee schedule,$58.94 ,47% of billed charges or 100% of CAH Medicare ,$58.94 ,47% of billed charges or 100% of CAH Medicare ,$20.63 ,$73.67 ,$125.40 
Outpatient Medical Services,LAB,84403,Testosterone Serum,301,$237.00 ,$139.24 ,58.75% of billed charges or 125% of CAH Medicare ,$139.24 ,58.75% of billed charges or 125% of CAH Medicare ,$114.73 ,48.41% of billed charges or 125% of CAH Medicare ,$31.55 ,100% of custom fee schedule,$31.55 ,100% of custom fee schedule,$111.39 ,47% of billed charges or 100% of CAH Medicare ,$31.55 ,100% of custom fee schedule,$139.24 ,58.75% of billed charges or 125% of CAH Medicare ,$27.65 ,100% AR Medicaid ,$111.39 ,47% of billed charges or 100% of CAH Medicare ,$36.87 ,100% AR Medicaid ,$111.39 ,47% of billed charges or 100% of CAH Medicare ,$20.91 ,90% for custom fee schedule,$111.39 ,47% of billed charges or 100% of CAH Medicare ,$111.39 ,47% of billed charges or 100% of CAH Medicare ,$20.91 ,$139.24 ,$237.00 
Outpatient Medical Services,LAB,84425,Vitamin B1 Thiamine,301,$117.60 ,$69.09 ,58.75% of billed charges or 125% of CAH Medicare ,$69.09 ,58.75% of billed charges or 125% of CAH Medicare ,$56.93 ,48.41% of billed charges or 125% of CAH Medicare ,$25.95 ,100% of custom fee schedule,$25.95 ,100% of custom fee schedule,$55.27 ,47% of billed charges or 100% of CAH Medicare ,$25.95 ,100% of custom fee schedule,$69.09 ,58.75% of billed charges or 125% of CAH Medicare ,$22.75 ,100% AR Medicaid ,$55.27 ,47% of billed charges or 100% of CAH Medicare ,$30.33 ,100% AR Medicaid ,$55.27 ,47% of billed charges or 100% of CAH Medicare ,$17.20 ,90% for custom fee schedule,$55.27 ,47% of billed charges or 100% of CAH Medicare ,$55.27 ,47% of billed charges or 100% of CAH Medicare ,$17.20 ,$69.09 ,$117.60 
Outpatient Medical Services,LAB,84436,T-4 Thyroxine,301,$105.60 ,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$51.12 ,48.41% of billed charges or 125% of CAH Medicare ,$8.39 ,100% of custom fee schedule,$8.39 ,100% of custom fee schedule,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$8.39 ,100% of custom fee schedule,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$6.68 ,100% AR Medicaid ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$8.90 ,100% AR Medicaid ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$5.56 ,90% for custom fee schedule,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$5.56 ,$62.04 ,$105.60 
Outpatient Medical Services,LAB,84439,Free T-4,301,$57.00 ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$27.59 ,48.41% of billed charges or 125% of CAH Medicare ,$11.02 ,100% of custom fee schedule,$11.02 ,100% of custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$11.02 ,100% of custom fee schedule,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$9.66 ,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$12.88 ,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$7.31 ,90% for custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$7.31 ,$33.49 ,$57.00 
Outpatient Medical Services,LAB,84443,"Thyroid Hormone  TSH(Blood Test, Thyroid Stimulating Hormone   *",301,$100.00 ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$48.41 ,48.41% of billed charges or 125% of CAH Medicare ,$20.54 ,100% of custom fee schedule,$20.54 ,100% of custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$20.54 ,100% of custom fee schedule,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$17.99 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$23.98 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$13.61 ,90% for custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$13.61 ,$58.75 ,$100.00 
Outpatient Medical Services,LAB,84450,Transaminase SGOT,301,$71.00 ,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$34.37 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$41.71 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$7.38 ,100% AR Medicaid ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$33.37 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$41.71 ,$71.00 
Outpatient Medical Services,LAB,84460,Transaminase SGPT,301,$69.00 ,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$33.40 ,48.41% of billed charges or 125% of CAH Medicare ,$6.48 ,100% of custom fee schedule,$6.48 ,100% of custom fee schedule,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$6.48 ,100% of custom fee schedule,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$5.67 ,100% AR Medicaid ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$7.56 ,100% AR Medicaid ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$4.29 ,90% for custom fee schedule,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$4.29 ,$40.54 ,$69.00 
Outpatient Medical Services,LAB,84478,Triglytcerides,301,$128.00 ,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$61.96 ,48.41% of billed charges or 125% of CAH Medicare ,$7.02 ,100% of custom fee schedule,$7.02 ,100% of custom fee schedule,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$7.02 ,100% of custom fee schedule,$75.20 ,58.75% of billed charges or 125% of CAH Medicare ,$6.17 ,100% AR Medicaid ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$8.22 ,100% AR Medicaid ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$4.65 ,90% for custom fee schedule,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$60.16 ,47% of billed charges or 100% of CAH Medicare ,$4.65 ,$75.20 ,$128.00 
Outpatient Medical Services,LAB,84479,T-3 Uptake,301,$88.00 ,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$42.60 ,48.41% of billed charges or 125% of CAH Medicare ,$7.90 ,100% of custom fee schedule,$7.90 ,100% of custom fee schedule,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$7.90 ,100% of custom fee schedule,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$6.94 ,100% AR Medicaid ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$9.25 ,100% AR Medicaid ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$5.24 ,90% for custom fee schedule,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$5.24 ,$51.70 ,$88.00 
Outpatient Medical Services,LAB,84480,T-3 Total,301,$82.96 ,$48.74 ,58.75% of billed charges or 125% of CAH Medicare ,$48.74 ,58.75% of billed charges or 125% of CAH Medicare ,$40.16 ,48.41% of billed charges or 125% of CAH Medicare ,$17.33 ,100% of custom fee schedule,$17.33 ,100% of custom fee schedule,$38.99 ,47% of billed charges or 100% of CAH Medicare ,$17.33 ,100% of custom fee schedule,$48.74 ,58.75% of billed charges or 125% of CAH Medicare ,$15.19 ,100% AR Medicaid ,$38.99 ,47% of billed charges or 100% of CAH Medicare ,$20.25 ,100% AR Medicaid ,$38.99 ,47% of billed charges or 100% of CAH Medicare ,$11.48 ,90% for custom fee schedule,$38.99 ,47% of billed charges or 100% of CAH Medicare ,$38.99 ,47% of billed charges or 100% of CAH Medicare ,$11.48 ,$48.74 ,$82.96 
Outpatient Medical Services,LAB,84481,Free T-3,301,$120.00 ,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$58.09 ,48.41% of billed charges or 125% of CAH Medicare ,$20.70 ,100% of custom fee schedule,$20.70 ,100% of custom fee schedule,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$20.70 ,100% of custom fee schedule,$70.50 ,58.75% of billed charges or 125% of CAH Medicare ,$18.14 ,100% AR Medicaid ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$24.19 ,100% AR Medicaid ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$13.73 ,90% for custom fee schedule,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$56.40 ,47% of billed charges or 100% of CAH Medicare ,$13.73 ,$70.50 ,$120.00 
Outpatient Medical Services,LAB,84482,Reverse T3 Serum,301,$235.80 ,$138.53 ,58.75% of billed charges or 125% of CAH Medicare ,$138.53 ,58.75% of billed charges or 125% of CAH Medicare ,$114.15 ,48.41% of billed charges or 125% of CAH Medicare ,$19.26 ,100% of custom fee schedule,$19.26 ,100% of custom fee schedule,$110.83 ,47% of billed charges or 100% of CAH Medicare ,$19.26 ,100% of custom fee schedule,$138.53 ,58.75% of billed charges or 125% of CAH Medicare ,$16.88 ,100% AR Medicaid ,$110.83 ,47% of billed charges or 100% of CAH Medicare ,$22.51 ,100% AR Medicaid ,$110.83 ,47% of billed charges or 100% of CAH Medicare ,$12.76 ,90% for custom fee schedule,$110.83 ,47% of billed charges or 100% of CAH Medicare ,$110.83 ,47% of billed charges or 100% of CAH Medicare ,$12.76 ,$138.53 ,$235.80 
Outpatient Medical Services,LAB,84484,Troponin,301,$166.40 ,$97.76 ,58.75% of billed charges or 125% of CAH Medicare ,$97.76 ,58.75% of billed charges or 125% of CAH Medicare ,$80.55 ,48.41% of billed charges or 125% of CAH Medicare ,$12.78 ,100% of custom fee schedule,$12.78 ,100% of custom fee schedule,$78.21 ,47% of billed charges or 100% of CAH Medicare ,$12.78 ,100% of custom fee schedule,$97.76 ,58.75% of billed charges or 125% of CAH Medicare ,$10.54 ,100% AR Medicaid ,$78.21 ,47% of billed charges or 100% of CAH Medicare ,$14.05 ,100% AR Medicaid ,$78.21 ,47% of billed charges or 100% of CAH Medicare ,$10.10 ,90% for custom fee schedule,$78.21 ,47% of billed charges or 100% of CAH Medicare ,$78.21 ,47% of billed charges or 100% of CAH Medicare ,$10.10 ,$97.76 ,$166.40 
Outpatient Medical Services,CT,84520,BUN,300,$133.10 ,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$64.43 ,48.41% of billed charges or 125% of CAH Medicare ,$4.83 ,100% of custom fee schedule,$4.83 ,100% of custom fee schedule,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$4.83 ,100% of custom fee schedule,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$4.22 ,100% AR Medicaid ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$5.63 ,100% AR Medicaid ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$3.20 ,90% for custom fee schedule,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$3.20 ,$78.20 ,$133.10 
Outpatient Medical Services,LAB,84520,Bun,300,$133.10 ,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$64.43 ,48.41% of billed charges or 125% of CAH Medicare ,$4.83 ,100% of custom fee schedule,$4.83 ,100% of custom fee schedule,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$4.83 ,100% of custom fee schedule,$78.20 ,58.75% of billed charges or 125% of CAH Medicare ,$4.22 ,100% AR Medicaid ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$5.63 ,100% AR Medicaid ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$3.20 ,90% for custom fee schedule,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$62.56 ,47% of billed charges or 100% of CAH Medicare ,$3.20 ,$78.20 ,$133.10 
Outpatient Medical Services,LAB,84550,Uric Acid Blood,301,$68.95 ,$40.51 ,58.75% of billed charges or 125% of CAH Medicare ,$40.51 ,58.75% of billed charges or 125% of CAH Medicare ,$33.38 ,48.41% of billed charges or 125% of CAH Medicare ,$5.52 ,100% of custom fee schedule,$5.52 ,100% of custom fee schedule,$32.41 ,47% of billed charges or 100% of CAH Medicare ,$5.52 ,100% of custom fee schedule,$40.51 ,58.75% of billed charges or 125% of CAH Medicare ,$4.85 ,100% AR Medicaid ,$32.41 ,47% of billed charges or 100% of CAH Medicare ,$6.46 ,100% AR Medicaid ,$32.41 ,47% of billed charges or 100% of CAH Medicare ,$3.66 ,90% for custom fee schedule,$32.41 ,47% of billed charges or 100% of CAH Medicare ,$32.41 ,47% of billed charges or 100% of CAH Medicare ,$3.66 ,$40.51 ,$68.95 
Outpatient Medical Services,LAB,84681,C  Peptine,301,$17.77 ,$10.44 ,58.75% of billed charges or 125% of CAH Medicare ,$10.44 ,58.75% of billed charges or 125% of CAH Medicare ,$8.60 ,48.41% of billed charges or 125% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$25.44 ,100% of custom fee schedule,$8.35 ,47% of billed charges or 100% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$10.44 ,58.75% of billed charges or 125% of CAH Medicare ,$22.28 ,100% AR Medicaid ,$8.35 ,47% of billed charges or 100% of CAH Medicare ,$29.71 ,100% AR Medicaid ,$8.35 ,47% of billed charges or 100% of CAH Medicare ,$16.86 ,90% for custom fee schedule,$8.35 ,47% of billed charges or 100% of CAH Medicare ,$8.35 ,47% of billed charges or 100% of CAH Medicare ,$8.35 ,$29.71 ,$17.77 
Outpatient Medical Services,LAB,84702,HCG Quantitative,300,$38.00 ,$22.33 ,58.75% of billed charges or 125% of CAH Medicare ,$22.33 ,58.75% of billed charges or 125% of CAH Medicare ,$18.40 ,48.41% of billed charges or 125% of CAH Medicare ,$18.40 ,100% of custom fee schedule,$18.40 ,100% of custom fee schedule,$17.86 ,47% of billed charges or 100% of CAH Medicare ,$18.40 ,100% of custom fee schedule,$22.33 ,58.75% of billed charges or 125% of CAH Medicare ,$8.66 ,100% AR Medicaid ,$17.86 ,47% of billed charges or 100% of CAH Medicare ,$11.54 ,100% AR Medicaid ,$17.86 ,47% of billed charges or 100% of CAH Medicare ,$12.20 ,90% for custom fee schedule,$17.86 ,47% of billed charges or 100% of CAH Medicare ,$17.86 ,47% of billed charges or 100% of CAH Medicare ,$8.66 ,$22.33 ,$38.00 
Outpatient Medical Services,LAB,84703,HCG Slide,300,$61.00 ,$35.84 ,58.75% of billed charges or 125% of CAH Medicare ,$35.84 ,58.75% of billed charges or 125% of CAH Medicare ,$29.53 ,48.41% of billed charges or 125% of CAH Medicare ,$9.20 ,100% of custom fee schedule,$9.20 ,100% of custom fee schedule,$28.67 ,47% of billed charges or 100% of CAH Medicare ,$9.20 ,100% of custom fee schedule,$35.84 ,58.75% of billed charges or 125% of CAH Medicare ,$8.05 ,100% AR Medicaid ,$28.67 ,47% of billed charges or 100% of CAH Medicare ,$10.73 ,100% AR Medicaid ,$28.67 ,47% of billed charges or 100% of CAH Medicare ,$6.09 ,90% for custom fee schedule,$28.67 ,47% of billed charges or 100% of CAH Medicare ,$28.67 ,47% of billed charges or 100% of CAH Medicare ,$6.09 ,$35.84 ,$61.00 
Outpatient Medical Services,LAB,85014,Hematocrit,305,$66.00 ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$31.95 ,48.41% of billed charges or 125% of CAH Medicare ,$2.89 ,100% of custom fee schedule,$2.89 ,100% of custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$2.89 ,100% of custom fee schedule,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$2.54 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$3.38 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$1.92 ,90% for custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$1.92 ,$38.78 ,$66.00 
Outpatient Medical Services,LAB,85018,Hemoglobin,305,$66.00 ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$31.95 ,48.41% of billed charges or 125% of CAH Medicare ,$2.89 ,100% of custom fee schedule,$2.89 ,100% of custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$2.89 ,100% of custom fee schedule,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$2.54 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$3.38 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$1.92 ,90% for custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$1.92 ,$38.78 ,$66.00 
Outpatient Medical Services,LAB,85025,"CBC with differential white blood cells, Automated *",305,$118.60 ,$69.68 ,58.75% of billed charges or 125% of CAH Medicare ,$69.68 ,58.75% of billed charges or 125% of CAH Medicare ,$57.41 ,48.41% of billed charges or 125% of CAH Medicare ,$9.49 ,100% of custom fee schedule,$9.49 ,100% of custom fee schedule,$55.74 ,47% of billed charges or 100% of CAH Medicare ,$9.49 ,100% of custom fee schedule,$69.68 ,58.75% of billed charges or 125% of CAH Medicare ,$8.33 ,100% AR Medicaid ,$55.74 ,47% of billed charges or 100% of CAH Medicare ,$11.10 ,100% AR Medicaid ,$55.74 ,47% of billed charges or 100% of CAH Medicare ,$6.29 ,90% for custom fee schedule,$55.74 ,47% of billed charges or 100% of CAH Medicare ,$55.74 ,47% of billed charges or 100% of CAH Medicare ,$6.29 ,$69.68 ,$118.60 
Outpatient Medical Services,LAB,85045,Reticul Count,305,$51.70 ,$30.37 ,58.75% of billed charges or 125% of CAH Medicare ,$30.37 ,58.75% of billed charges or 125% of CAH Medicare ,$25.03 ,48.41% of billed charges or 125% of CAH Medicare ,$4.88 ,100% of custom fee schedule,$4.88 ,100% of custom fee schedule,$24.30 ,47% of billed charges or 100% of CAH Medicare ,$4.88 ,100% of custom fee schedule,$30.37 ,58.75% of billed charges or 125% of CAH Medicare ,$4.29 ,100% AR Medicaid ,$24.30 ,47% of billed charges or 100% of CAH Medicare ,$5.72 ,100% AR Medicaid ,$24.30 ,47% of billed charges or 100% of CAH Medicare ,$3.23 ,90% for custom fee schedule,$24.30 ,47% of billed charges or 100% of CAH Medicare ,$24.30 ,47% of billed charges or 100% of CAH Medicare ,$3.23 ,$30.37 ,$51.70 
Outpatient Medical Services,LAB,85048,WBC,305,$39.00 ,$22.91 ,58.75% of billed charges or 125% of CAH Medicare ,$22.91 ,58.75% of billed charges or 125% of CAH Medicare ,$18.88 ,48.41% of billed charges or 125% of CAH Medicare ,$3.10 ,100% of custom fee schedule,$3.10 ,100% of custom fee schedule,$18.33 ,47% of billed charges or 100% of CAH Medicare ,$3.10 ,100% of custom fee schedule,$22.91 ,58.75% of billed charges or 125% of CAH Medicare ,$2.73 ,100% AR Medicaid ,$18.33 ,47% of billed charges or 100% of CAH Medicare ,$3.64 ,100% AR Medicaid ,$18.33 ,47% of billed charges or 100% of CAH Medicare ,$2.06 ,90% for custom fee schedule,$18.33 ,47% of billed charges or 100% of CAH Medicare ,$18.33 ,47% of billed charges or 100% of CAH Medicare ,$2.06 ,$22.91 ,$39.00 
Outpatient Medical Services,LAB,85049,Platelet Count,305,$52.80 ,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$25.56 ,48.41% of billed charges or 125% of CAH Medicare ,$5.47 ,100% of custom fee schedule,$5.47 ,100% of custom fee schedule,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$5.47 ,100% of custom fee schedule,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$4.69 ,100% AR Medicaid ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$6.25 ,100% AR Medicaid ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$3.63 ,90% for custom fee schedule,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$3.63 ,$31.02 ,$52.80 
Outpatient Medical Services,LAB,85379,D-Dimer,300,$83.50 ,$49.06 ,58.75% of billed charges or 125% of CAH Medicare ,$49.06 ,58.75% of billed charges or 125% of CAH Medicare ,$40.42 ,48.41% of billed charges or 125% of CAH Medicare ,$12.44 ,100% of custom fee schedule,$12.44 ,100% of custom fee schedule,$39.25 ,47% of billed charges or 100% of CAH Medicare ,$12.44 ,100% of custom fee schedule,$49.06 ,58.75% of billed charges or 125% of CAH Medicare ,$10.90 ,100% AR Medicaid ,$39.25 ,47% of billed charges or 100% of CAH Medicare ,$14.53 ,100% AR Medicaid ,$39.25 ,47% of billed charges or 100% of CAH Medicare ,$8.24 ,90% for custom fee schedule,$39.25 ,47% of billed charges or 100% of CAH Medicare ,$39.25 ,47% of billed charges or 100% of CAH Medicare ,$8.24 ,$49.06 ,$83.50 
Outpatient Medical Services,LAB,85610,"Prothrombin Time PT Blood Test, Clotting Time     *",300,$149.70 ,$87.95 ,58.75% of billed charges or 125% of CAH Medicare ,$87.95 ,58.75% of billed charges or 125% of CAH Medicare ,$72.47 ,48.41% of billed charges or 125% of CAH Medicare ,$4.81 ,100% of custom fee schedule,$4.81 ,100% of custom fee schedule,$70.36 ,47% of billed charges or 100% of CAH Medicare ,$4.81 ,100% of custom fee schedule,$87.95 ,58.75% of billed charges or 125% of CAH Medicare ,$4.21 ,100% AR Medicaid ,$70.36 ,47% of billed charges or 100% of CAH Medicare ,$5.61 ,100% AR Medicaid ,$70.36 ,47% of billed charges or 100% of CAH Medicare ,$3.47 ,90% for custom fee schedule,$70.36 ,47% of billed charges or 100% of CAH Medicare ,$70.36 ,47% of billed charges or 100% of CAH Medicare ,$3.47 ,$87.95 ,$149.70 
Outpatient Medical Services,LAB,85660,Hemogl Sicke Solub,305,$51.00 ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$24.69 ,48.41% of billed charges or 125% of CAH Medicare ,$6.73 ,100% of custom fee schedule,$6.73 ,100% of custom fee schedule,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$6.73 ,100% of custom fee schedule,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$5.91 ,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$7.88 ,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$4.46 ,90% for custom fee schedule,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$4.46 ,$29.96 ,$51.00 
Outpatient Medical Services,LAB,85730,PTT Coagulation Assessment Blood Test    *,300,$112.00 ,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,$54.22 ,48.41% of billed charges or 125% of CAH Medicare ,$7.34 ,100% of custom fee schedule,$7.34 ,100% of custom fee schedule,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$7.34 ,100% of custom fee schedule,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,$6.44 ,100% AR Medicaid ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$8.58 ,100% AR Medicaid ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$4.87 ,90% for custom fee schedule,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$4.87 ,$65.80 ,$112.00 
Outpatient Medical Services,LAB,86038,Anti Nuclear Abdy,302,$70.00 ,$41.13 ,58.75% of billed charges or 125% of CAH Medicare ,$41.13 ,58.75% of billed charges or 125% of CAH Medicare ,$33.89 ,48.41% of billed charges or 125% of CAH Medicare ,$14.77 ,100% of custom fee schedule,$14.77 ,100% of custom fee schedule,$32.90 ,47% of billed charges or 100% of CAH Medicare ,$14.77 ,100% of custom fee schedule,$41.13 ,58.75% of billed charges or 125% of CAH Medicare ,$12.95 ,100% AR Medicaid ,$32.90 ,47% of billed charges or 100% of CAH Medicare ,$17.26 ,100% AR Medicaid ,$32.90 ,47% of billed charges or 100% of CAH Medicare ,$9.79 ,90% for custom fee schedule,$32.90 ,47% of billed charges or 100% of CAH Medicare ,$32.90 ,47% of billed charges or 100% of CAH Medicare ,$9.79 ,$41.13 ,$70.00 
Outpatient Medical Services,LAB,86140,CRP,300,$86.90 ,$51.05 ,58.75% of billed charges or 125% of CAH Medicare ,$51.05 ,58.75% of billed charges or 125% of CAH Medicare ,$42.07 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$40.84 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$51.05 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$40.84 ,47% of billed charges or 100% of CAH Medicare ,$7.39 ,100% AR Medicaid ,$40.84 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$40.84 ,47% of billed charges or 100% of CAH Medicare ,$40.84 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$51.05 ,$86.90 
Outpatient Medical Services,LAB,86141,CRP Cardio,300,$72.00 ,$42.30 ,58.75% of billed charges or 125% of CAH Medicare ,$42.30 ,58.75% of billed charges or 125% of CAH Medicare ,$34.86 ,48.41% of billed charges or 125% of CAH Medicare ,$15.83 ,100% of custom fee schedule,$15.83 ,100% of custom fee schedule,$33.84 ,47% of billed charges or 100% of CAH Medicare ,$15.83 ,100% of custom fee schedule,$42.30 ,58.75% of billed charges or 125% of CAH Medicare ,$13.42 ,100% AR Medicaid ,$33.84 ,47% of billed charges or 100% of CAH Medicare ,$17.89 ,100% AR Medicaid ,$33.84 ,47% of billed charges or 100% of CAH Medicare ,$10.49 ,90% for custom fee schedule,$33.84 ,47% of billed charges or 100% of CAH Medicare ,$33.84 ,47% of billed charges or 100% of CAH Medicare ,$10.49 ,$42.30 ,$72.00 
Outpatient Medical Services,LAB,86200,CCP Antibodies IGG/IGA,302,$100.20 ,$58.87 ,58.75% of billed charges or 125% of CAH Medicare ,$58.87 ,58.75% of billed charges or 125% of CAH Medicare ,$48.51 ,48.41% of billed charges or 125% of CAH Medicare ,$15.83 ,100% of custom fee schedule,$15.83 ,100% of custom fee schedule,$47.09 ,47% of billed charges or 100% of CAH Medicare ,$15.83 ,100% of custom fee schedule,$58.87 ,58.75% of billed charges or 125% of CAH Medicare ,$14.02 ,100% AR Medicaid ,$47.09 ,47% of billed charges or 100% of CAH Medicare ,$18.69 ,100% AR Medicaid ,$47.09 ,47% of billed charges or 100% of CAH Medicare ,$10.49 ,90% for custom fee schedule,$47.09 ,47% of billed charges or 100% of CAH Medicare ,$47.09 ,47% of billed charges or 100% of CAH Medicare ,$10.49 ,$58.87 ,$100.20 
Outpatient Medical Services,LAB,86300,CA 27.29,300,$169.00 ,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,$81.81 ,48.41% of billed charges or 125% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$25.44 ,100% of custom fee schedule,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,$22.29 ,100% AR Medicaid ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$29.72 ,100% AR Medicaid ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$16.86 ,90% for custom fee schedule,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$16.86 ,$99.29 ,$169.00 
Outpatient Medical Services,LAB,86301,CA 19-9,300,$42.90 ,$25.20 ,58.75% of billed charges or 125% of CAH Medicare ,$25.20 ,58.75% of billed charges or 125% of CAH Medicare ,$20.77 ,48.41% of billed charges or 125% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$25.44 ,100% of custom fee schedule,$20.16 ,47% of billed charges or 100% of CAH Medicare ,$25.44 ,100% of custom fee schedule,$25.20 ,58.75% of billed charges or 125% of CAH Medicare ,$22.29 ,100% AR Medicaid ,$20.16 ,47% of billed charges or 100% of CAH Medicare ,$29.72 ,100% AR Medicaid ,$20.16 ,47% of billed charges or 100% of CAH Medicare ,$16.86 ,90% for custom fee schedule,$20.16 ,47% of billed charges or 100% of CAH Medicare ,$20.16 ,47% of billed charges or 100% of CAH Medicare ,$16.86 ,$29.72 ,$42.90 
Outpatient Medical Services,LAB,86308,Mono Test,302,$62.70 ,$36.84 ,58.75% of billed charges or 125% of CAH Medicare ,$36.84 ,58.75% of billed charges or 125% of CAH Medicare ,$30.35 ,48.41% of billed charges or 125% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$6.33 ,100% of custom fee schedule,$29.47 ,47% of billed charges or 100% of CAH Medicare ,$6.33 ,100% of custom fee schedule,$36.84 ,58.75% of billed charges or 125% of CAH Medicare ,$5.54 ,100% AR Medicaid ,$29.47 ,47% of billed charges or 100% of CAH Medicare ,$7.39 ,100% AR Medicaid ,$29.47 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,90% for custom fee schedule,$29.47 ,47% of billed charges or 100% of CAH Medicare ,$29.47 ,47% of billed charges or 100% of CAH Medicare ,$4.19 ,$36.84 ,$62.70 
Outpatient Medical Services,LAB,86376,Thyroid Peroxidase (TPO) AB,302,$30.00 ,$17.63 ,58.75% of billed charges or 125% of CAH Medicare ,$17.63 ,58.75% of billed charges or 125% of CAH Medicare ,$14.52 ,48.41% of billed charges or 125% of CAH Medicare ,$17.79 ,100% of custom fee schedule,$17.79 ,100% of custom fee schedule,$14.10 ,47% of billed charges or 100% of CAH Medicare ,$17.79 ,100% of custom fee schedule,$17.63 ,58.75% of billed charges or 125% of CAH Medicare ,$15.59 ,100% AR Medicaid ,$14.10 ,47% of billed charges or 100% of CAH Medicare ,$20.78 ,100% AR Medicaid ,$14.10 ,47% of billed charges or 100% of CAH Medicare ,$11.79 ,90% for custom fee schedule,$14.10 ,47% of billed charges or 100% of CAH Medicare ,$14.10 ,47% of billed charges or 100% of CAH Medicare ,$11.79 ,$20.78 ,$30.00 
Outpatient Medical Services,LAB,86430,Rheumaatoid Fact/Qual,302,$64.00 ,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$30.98 ,48.41% of billed charges or 125% of CAH Medicare ,$6.93 ,100% of custom fee schedule,$6.93 ,100% of custom fee schedule,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$6.93 ,100% of custom fee schedule,$37.60 ,58.75% of billed charges or 125% of CAH Medicare ,$6.08 ,100% AR Medicaid ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$8.11 ,100% AR Medicaid ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$4.98 ,90% for custom fee schedule,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$30.08 ,47% of billed charges or 100% of CAH Medicare ,$4.98 ,$37.60 ,$64.00 
Outpatient Medical Services,LAB,86480,Quantiferon-TB Gold Plus,301,$118.55 ,$69.65 ,58.75% of billed charges or 125% of CAH Medicare ,$69.65 ,58.75% of billed charges or 125% of CAH Medicare ,$57.39 ,48.41% of billed charges or 125% of CAH Medicare ,$75.76 ,100% of custom fee schedule,$75.76 ,100% of custom fee schedule,$55.72 ,47% of billed charges or 100% of CAH Medicare ,$75.76 ,100% of custom fee schedule,$69.65 ,58.75% of billed charges or 125% of CAH Medicare ,$67.11 ,100% AR Medicaid ,$55.72 ,47% of billed charges or 100% of CAH Medicare ,$89.48 ,100% AR Medicaid ,$55.72 ,47% of billed charges or 100% of CAH Medicare ,$50.20 ,90% for custom fee schedule,$55.72 ,47% of billed charges or 100% of CAH Medicare ,$55.72 ,47% of billed charges or 100% of CAH Medicare ,$50.20 ,$89.48 ,$118.55 
Outpatient Medical Services,LAB,86551,Sedimentation Rate 1,300,$55.65 ,$32.69 ,58.75% of billed charges or 125% of CAH Medicare ,$32.69 ,58.75% of billed charges or 125% of CAH Medicare ,$26.94 ,48.41% of billed charges or 125% of CAH Medicare ,$50.09 ,90% of total billed charges,$50.09 ,90% of total billed charges,$26.16 ,47% of billed charges or 100% of CAH Medicare ,$50.09 ,90% of total billed charges,$32.69 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$26.16 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$26.16 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$26.16 ,47% of billed charges or 100% of CAH Medicare ,$26.16 ,47% of billed charges or 100% of CAH Medicare ,$26.16 ,$50.09 ,$55.65 
Outpatient Medical Services,LAB,86592,RPH-Qual,302,$50.60 ,$29.73 ,58.75% of billed charges or 125% of CAH Medicare ,$29.73 ,58.75% of billed charges or 125% of CAH Medicare ,$24.50 ,48.41% of billed charges or 125% of CAH Medicare ,$5.23 ,100% of custom fee schedule,$5.23 ,100% of custom fee schedule,$23.78 ,47% of billed charges or 100% of CAH Medicare ,$5.23 ,100% of custom fee schedule,$29.73 ,58.75% of billed charges or 125% of CAH Medicare ,$4.58 ,100% AR Medicaid ,$23.78 ,47% of billed charges or 100% of CAH Medicare ,$6.10 ,100% AR Medicaid ,$23.78 ,47% of billed charges or 100% of CAH Medicare ,$3.46 ,90% for custom fee schedule,$23.78 ,47% of billed charges or 100% of CAH Medicare ,$23.78 ,47% of billed charges or 100% of CAH Medicare ,$3.46 ,$29.73 ,$50.60 
Outpatient Medical Services,LAB,86618,Lymes Test,302,$150.00 ,$88.13 ,58.75% of billed charges or 125% of CAH Medicare ,$88.13 ,58.75% of billed charges or 125% of CAH Medicare ,$72.62 ,48.41% of billed charges or 125% of CAH Medicare ,$20.81 ,100% of custom fee schedule,$20.81 ,100% of custom fee schedule,$70.50 ,47% of billed charges or 100% of CAH Medicare ,$20.81 ,100% of custom fee schedule,$88.13 ,58.75% of billed charges or 125% of CAH Medicare ,$18.24 ,100% AR Medicaid ,$70.50 ,47% of billed charges or 100% of CAH Medicare ,$24.32 ,100% AR Medicaid ,$70.50 ,47% of billed charges or 100% of CAH Medicare ,$13.80 ,90% for custom fee schedule,$70.50 ,47% of billed charges or 100% of CAH Medicare ,$70.50 ,47% of billed charges or 100% of CAH Medicare ,$13.80 ,$88.13 ,$150.00 
Outpatient Medical Services,LAB,86666,Ehrlichia Chaffeesis PCR,302,$218.10 ,$128.13 ,58.75% of billed charges or 125% of CAH Medicare ,$128.13 ,58.75% of billed charges or 125% of CAH Medicare ,$105.58 ,48.41% of billed charges or 125% of CAH Medicare ,$12.44 ,100% of custom fee schedule,$12.44 ,100% of custom fee schedule,$102.51 ,47% of billed charges or 100% of CAH Medicare ,$12.44 ,100% of custom fee schedule,$128.13 ,58.75% of billed charges or 125% of CAH Medicare ,$10.90 ,100% AR Medicaid ,$102.51 ,47% of billed charges or 100% of CAH Medicare ,$14.53 ,100% AR Medicaid ,$102.51 ,47% of billed charges or 100% of CAH Medicare ,$8.24 ,90% for custom fee schedule,$102.51 ,47% of billed charges or 100% of CAH Medicare ,$102.51 ,47% of billed charges or 100% of CAH Medicare ,$8.24 ,$128.13 ,$218.10 
Outpatient Medical Services,LAB,86677,Helicobacter Pylori,300,$141.10 ,$82.90 ,58.75% of billed charges or 125% of CAH Medicare ,$82.90 ,58.75% of billed charges or 125% of CAH Medicare ,$68.31 ,48.41% of billed charges or 125% of CAH Medicare ,$18.36 ,100% of custom fee schedule,$18.36 ,100% of custom fee schedule,$66.32 ,47% of billed charges or 100% of CAH Medicare ,$18.36 ,100% of custom fee schedule,$82.90 ,58.75% of billed charges or 125% of CAH Medicare ,$15.54 ,100% AR Medicaid ,$66.32 ,47% of billed charges or 100% of CAH Medicare ,$20.72 ,100% AR Medicaid ,$66.32 ,47% of billed charges or 100% of CAH Medicare ,$13.65 ,90% for custom fee schedule,$66.32 ,47% of billed charges or 100% of CAH Medicare ,$66.32 ,47% of billed charges or 100% of CAH Medicare ,$13.65 ,$82.90 ,$141.10 
Outpatient Medical Services,LAB,86694,HSV 1 & 2 Antibodies 1 GM,302,$96.00 ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$46.47 ,48.41% of billed charges or 125% of CAH Medicare ,$17.59 ,100% of custom fee schedule,$17.59 ,100% of custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$17.59 ,100% of custom fee schedule,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$15.41 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$20.55 ,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$11.66 ,90% for custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$11.66 ,$56.40 ,$96.00 
Outpatient Medical Services,LAB,86695,HSV 1 & 2 Antibodies 1 GG,301,$112.50 ,$66.09 ,58.75% of billed charges or 125% of CAH Medicare ,$66.09 ,58.75% of billed charges or 125% of CAH Medicare ,$54.46 ,48.41% of billed charges or 125% of CAH Medicare ,$16.12 ,100% of custom fee schedule,$16.12 ,100% of custom fee schedule,$52.88 ,47% of billed charges or 100% of CAH Medicare ,$16.12 ,100% of custom fee schedule,$66.09 ,58.75% of billed charges or 125% of CAH Medicare ,$10.16 ,100% AR Medicaid ,$52.88 ,47% of billed charges or 100% of CAH Medicare ,$13.55 ,100% AR Medicaid ,$52.88 ,47% of billed charges or 100% of CAH Medicare ,$10.68 ,90% for custom fee schedule,$52.88 ,47% of billed charges or 100% of CAH Medicare ,$52.88 ,47% of billed charges or 100% of CAH Medicare ,$10.16 ,$66.09 ,$112.50 
Outpatient Medical Services,LAB,86703,HIV,302,$88.00 ,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$42.60 ,48.41% of billed charges or 125% of CAH Medicare ,$16.75 ,100% of custom fee schedule,$16.75 ,100% of custom fee schedule,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$16.75 ,100% of custom fee schedule,$51.70 ,58.75% of billed charges or 125% of CAH Medicare ,$14.69 ,100% AR Medicaid ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$19.59 ,100% AR Medicaid ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$11.11 ,90% for custom fee schedule,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$41.36 ,47% of billed charges or 100% of CAH Medicare ,$11.11 ,$51.70 ,$88.00 
Outpatient Medical Services,LAB,86706,Hepatitis B Surf Ant,302,$34.00 ,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$16.46 ,48.41% of billed charges or 125% of CAH Medicare ,$13.12 ,100% of custom fee schedule,$13.12 ,100% of custom fee schedule,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$13.12 ,100% of custom fee schedule,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$11.50 ,100% AR Medicaid ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$15.33 ,100% AR Medicaid ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$8.70 ,90% for custom fee schedule,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$8.70 ,$19.98 ,$34.00 
Outpatient Medical Services,LAB,86757,Rocky Mt Fever,302,$144.30 ,$84.78 ,58.75% of billed charges or 125% of CAH Medicare ,$84.78 ,58.75% of billed charges or 125% of CAH Medicare ,$69.86 ,48.41% of billed charges or 125% of CAH Medicare ,$23.66 ,100% of custom fee schedule,$23.66 ,100% of custom fee schedule,$67.82 ,47% of billed charges or 100% of CAH Medicare ,$23.66 ,100% of custom fee schedule,$84.78 ,58.75% of billed charges or 125% of CAH Medicare ,$20.73 ,100% AR Medicaid ,$67.82 ,47% of billed charges or 100% of CAH Medicare ,$27.64 ,100% AR Medicaid ,$67.82 ,47% of billed charges or 100% of CAH Medicare ,$15.68 ,90% for custom fee schedule,$67.82 ,47% of billed charges or 100% of CAH Medicare ,$67.82 ,47% of billed charges or 100% of CAH Medicare ,$15.68 ,$84.78 ,$144.30 
Outpatient Medical Services,LAB,86762,Rubella,302,$27.00 ,$15.86 ,58.75% of billed charges or 125% of CAH Medicare ,$15.86 ,58.75% of billed charges or 125% of CAH Medicare ,$13.07 ,48.41% of billed charges or 125% of CAH Medicare ,$17.59 ,100% of custom fee schedule,$17.59 ,100% of custom fee schedule,$12.69 ,47% of billed charges or 100% of CAH Medicare ,$17.59 ,100% of custom fee schedule,$15.86 ,58.75% of billed charges or 125% of CAH Medicare ,$15.41 ,100% AR Medicaid ,$12.69 ,47% of billed charges or 100% of CAH Medicare ,$20.55 ,100% AR Medicaid ,$12.69 ,47% of billed charges or 100% of CAH Medicare ,$11.66 ,90% for custom fee schedule,$12.69 ,47% of billed charges or 100% of CAH Medicare ,$12.69 ,47% of billed charges or 100% of CAH Medicare ,$11.66 ,$20.55 ,$27.00 
Outpatient Medical Services,LAB,86787,Varicella Zoster Virus Antib,302,$106.20 ,$62.39 ,58.75% of billed charges or 125% of CAH Medicare ,$62.39 ,58.75% of billed charges or 125% of CAH Medicare ,$51.41 ,48.41% of billed charges or 125% of CAH Medicare ,$15.74 ,100% of custom fee schedule,$15.74 ,100% of custom fee schedule,$49.91 ,47% of billed charges or 100% of CAH Medicare ,$15.74 ,100% of custom fee schedule,$62.39 ,58.75% of billed charges or 125% of CAH Medicare ,$13.80 ,100% AR Medicaid ,$49.91 ,47% of billed charges or 100% of CAH Medicare ,$18.40 ,100% AR Medicaid ,$49.91 ,47% of billed charges or 100% of CAH Medicare ,$10.43 ,90% for custom fee schedule,$49.91 ,47% of billed charges or 100% of CAH Medicare ,$49.91 ,47% of billed charges or 100% of CAH Medicare ,$10.43 ,$62.39 ,$106.20 
Outpatient Medical Services,LAB,86803,Hep C Virus Antibody,302,$105.60 ,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$51.12 ,48.41% of billed charges or 125% of CAH Medicare ,$17.44 ,100% of custom fee schedule,$17.44 ,100% of custom fee schedule,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$17.44 ,100% of custom fee schedule,$62.04 ,58.75% of billed charges or 125% of CAH Medicare ,$15.29 ,100% AR Medicaid ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$20.39 ,100% AR Medicaid ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$11.56 ,90% for custom fee schedule,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$49.63 ,47% of billed charges or 100% of CAH Medicare ,$11.56 ,$62.04 ,$105.60 
Outpatient Medical Services,LAB,86850,Anti-Bo Scr Indirect,302,$234.00 ,$137.48 ,58.75% of billed charges or 125% of CAH Medicare ,$137.48 ,58.75% of billed charges or 125% of CAH Medicare ,$113.28 ,48.41% of billed charges or 125% of CAH Medicare ,$45.01 ,100% of custom fee schedule,$45.01 ,100% of custom fee schedule,$109.98 ,47% of billed charges or 100% of CAH Medicare ,$45.01 ,100% of custom fee schedule,$137.48 ,58.75% of billed charges or 125% of CAH Medicare ,$6.60 ,100% AR Medicaid ,$109.98 ,47% of billed charges or 100% of CAH Medicare ,$8.80 ,100% AR Medicaid ,$109.98 ,47% of billed charges or 100% of CAH Medicare ,$7.91 ,90% for custom fee schedule,$109.98 ,47% of billed charges or 100% of CAH Medicare ,$109.98 ,47% of billed charges or 100% of CAH Medicare ,$6.60 ,$137.48 ,$234.00 
Outpatient Medical Services,LAB,86900,Blood Type ABO,302,$174.00 ,$102.23 ,58.75% of billed charges or 125% of CAH Medicare ,$102.23 ,58.75% of billed charges or 125% of CAH Medicare ,$84.23 ,48.41% of billed charges or 125% of CAH Medicare ,$99.20 ,100% of custom fee schedule,$99.20 ,100% of custom fee schedule,$81.78 ,47% of billed charges or 100% of CAH Medicare ,$99.20 ,100% of custom fee schedule,$102.23 ,58.75% of billed charges or 125% of CAH Medicare ,$3.20 ,100% AR Medicaid ,$81.78 ,47% of billed charges or 100% of CAH Medicare ,$4.26 ,100% AR Medicaid ,$81.78 ,47% of billed charges or 100% of CAH Medicare ,$2.42 ,90% for custom fee schedule,$81.78 ,47% of billed charges or 100% of CAH Medicare ,$81.78 ,47% of billed charges or 100% of CAH Medicare ,$2.42 ,$102.23 ,$174.00 
Outpatient Medical Services,LAB,86901,RHO (D) Type,302,$69.00 ,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$33.40 ,48.41% of billed charges or 125% of CAH Medicare ,$30.42 ,100% of custom fee schedule,$30.42 ,100% of custom fee schedule,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$30.42 ,100% of custom fee schedule,$40.54 ,58.75% of billed charges or 125% of CAH Medicare ,$15.00 ,100% AR Medicaid ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$20.00 ,100% AR Medicaid ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$2.42 ,90% for custom fee schedule,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$32.43 ,47% of billed charges or 100% of CAH Medicare ,$2.42 ,$40.54 ,$69.00 
Outpatient Medical Services,LAB,86922,Crossmatch EA Unit,302,$268.00 ,$157.45 ,58.75% of billed charges or 125% of CAH Medicare ,$157.45 ,58.75% of billed charges or 125% of CAH Medicare ,$129.74 ,48.41% of billed charges or 125% of CAH Medicare ,$130.55 ,100% of custom fee schedule,$130.55 ,100% of custom fee schedule,$125.96 ,47% of billed charges or 100% of CAH Medicare ,$130.55 ,100% of custom fee schedule,$157.45 ,58.75% of billed charges or 125% of CAH Medicare ,$51.63 ,100% AR Medicaid ,$125.96 ,47% of billed charges or 100% of CAH Medicare ,$68.84 ,100% AR Medicaid ,$125.96 ,47% of billed charges or 100% of CAH Medicare ,$123.38 ,90% for custom fee schedule,$125.96 ,47% of billed charges or 100% of CAH Medicare ,$125.96 ,47% of billed charges or 100% of CAH Medicare ,$51.63 ,$157.45 ,$268.00 
Outpatient Medical Services,LAB,87040,Culture Blood,306,$131.75 ,$77.40 ,58.75% of billed charges or 125% of CAH Medicare ,$77.40 ,58.75% of billed charges or 125% of CAH Medicare ,$63.78 ,48.41% of billed charges or 125% of CAH Medicare ,$12.62 ,100% of custom fee schedule,$12.62 ,100% of custom fee schedule,$61.92 ,47% of billed charges or 100% of CAH Medicare ,$12.62 ,100% of custom fee schedule,$77.40 ,58.75% of billed charges or 125% of CAH Medicare ,$11.06 ,100% AR Medicaid ,$61.92 ,47% of billed charges or 100% of CAH Medicare ,$14.75 ,100% AR Medicaid ,$61.92 ,47% of billed charges or 100% of CAH Medicare ,$8.36 ,90% for custom fee schedule,$61.92 ,47% of billed charges or 100% of CAH Medicare ,$61.92 ,47% of billed charges or 100% of CAH Medicare ,$8.36 ,$77.40 ,$131.75 
Outpatient Medical Services,LAB,87045,Stool Culture,306,$288.00 ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$139.42 ,48.41% of billed charges or 125% of CAH Medicare ,$11.54 ,100% of custom fee schedule,$11.54 ,100% of custom fee schedule,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$11.54 ,100% of custom fee schedule,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$10.10 ,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$13.47 ,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$7.65 ,90% for custom fee schedule,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$7.65 ,$169.20 ,$288.00 
Outpatient Medical Services,LAB,87070,Culture Any,306,$117.00 ,$68.74 ,58.75% of billed charges or 125% of CAH Medicare ,$68.74 ,58.75% of billed charges or 125% of CAH Medicare ,$56.64 ,48.41% of billed charges or 125% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$10.53 ,100% of custom fee schedule,$54.99 ,47% of billed charges or 100% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$68.74 ,58.75% of billed charges or 125% of CAH Medicare ,$9.23 ,100% AR Medicaid ,$54.99 ,47% of billed charges or 100% of CAH Medicare ,$12.30 ,100% AR Medicaid ,$54.99 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$54.99 ,47% of billed charges or 100% of CAH Medicare ,$54.99 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,$68.74 ,$117.00 
Outpatient Medical Services,LAB,87070,Culture Sputum,306,$155.00 ,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$75.04 ,48.41% of billed charges or 125% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$10.53 ,100% of custom fee schedule,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$9.23 ,100% AR Medicaid ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$12.30 ,100% AR Medicaid ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,$91.06 ,$155.00 
Outpatient Medical Services,LAB,87070,Culture Wound,306,$127.75 ,$75.05 ,58.75% of billed charges or 125% of CAH Medicare ,$75.05 ,58.75% of billed charges or 125% of CAH Medicare ,$61.84 ,48.41% of billed charges or 125% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$10.53 ,100% of custom fee schedule,$60.04 ,47% of billed charges or 100% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$75.05 ,58.75% of billed charges or 125% of CAH Medicare ,$9.23 ,100% AR Medicaid ,$60.04 ,47% of billed charges or 100% of CAH Medicare ,$12.30 ,100% AR Medicaid ,$60.04 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$60.04 ,47% of billed charges or 100% of CAH Medicare ,$60.04 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,$75.05 ,$127.75 
Outpatient Medical Services,LAB,87070,Throat Culture,306,$135.00 ,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$65.35 ,48.41% of billed charges or 125% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$10.53 ,100% of custom fee schedule,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$10.53 ,100% of custom fee schedule,$79.31 ,58.75% of billed charges or 125% of CAH Medicare ,$9.23 ,100% AR Medicaid ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$12.30 ,100% AR Medicaid ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,90% for custom fee schedule,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$63.45 ,47% of billed charges or 100% of CAH Medicare ,$6.98 ,$79.31 ,$135.00 
Outpatient Medical Services,LAB,87086,Culture Urine,306,$155.00 ,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$75.04 ,48.41% of billed charges or 125% of CAH Medicare ,$9.87 ,100% of custom fee schedule,$9.87 ,100% of custom fee schedule,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$9.87 ,100% of custom fee schedule,$91.06 ,58.75% of billed charges or 125% of CAH Medicare ,$8.65 ,100% AR Medicaid ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$11.53 ,100% AR Medicaid ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$6.53 ,90% for custom fee schedule,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$72.85 ,47% of billed charges or 100% of CAH Medicare ,$6.53 ,$91.06 ,$155.00 
Outpatient Medical Services,LAB,87106,Culture Fungus,306,$210.00 ,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$101.66 ,48.41% of billed charges or 125% of CAH Medicare ,$12.62 ,100% of custom fee schedule,$12.62 ,100% of custom fee schedule,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$12.62 ,100% of custom fee schedule,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$8.78 ,100% AR Medicaid ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$11.70 ,100% AR Medicaid ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$8.36 ,90% for custom fee schedule,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$8.36 ,$123.38 ,$210.00 
Outpatient Medical Services,LAB,87116,Culture Acid Fast,306,$141.00 ,$82.84 ,58.75% of billed charges or 125% of CAH Medicare ,$82.84 ,58.75% of billed charges or 125% of CAH Medicare ,$68.26 ,48.41% of billed charges or 125% of CAH Medicare ,$13.20 ,100% of custom fee schedule,$13.20 ,100% of custom fee schedule,$66.27 ,47% of billed charges or 100% of CAH Medicare ,$13.20 ,100% of custom fee schedule,$82.84 ,58.75% of billed charges or 125% of CAH Medicare ,$11.57 ,100% AR Medicaid ,$66.27 ,47% of billed charges or 100% of CAH Medicare ,$15.43 ,100% AR Medicaid ,$66.27 ,47% of billed charges or 100% of CAH Medicare ,$8.75 ,90% for custom fee schedule,$66.27 ,47% of billed charges or 100% of CAH Medicare ,$66.27 ,47% of billed charges or 100% of CAH Medicare ,$8.75 ,$82.84 ,$141.00 
Outpatient Medical Services,LAB,87177,Ova & Parasities Co,306,$66.00 ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$31.95 ,48.41% of billed charges or 125% of CAH Medicare ,$10.88 ,100% of custom fee schedule,$10.88 ,100% of custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$10.88 ,100% of custom fee schedule,$38.78 ,58.75% of billed charges or 125% of CAH Medicare ,$9.53 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$12.71 ,100% AR Medicaid ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$7.21 ,90% for custom fee schedule,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$31.02 ,47% of billed charges or 100% of CAH Medicare ,$7.21 ,$38.78 ,$66.00 
Outpatient Medical Services,LAB,87186,Sensitive/Dis Per Org,306,$127.00 ,$74.61 ,58.75% of billed charges or 125% of CAH Medicare ,$74.61 ,58.75% of billed charges or 125% of CAH Medicare ,$61.48 ,48.41% of billed charges or 125% of CAH Medicare ,$10.57 ,100% of custom fee schedule,$10.57 ,100% of custom fee schedule,$59.69 ,47% of billed charges or 100% of CAH Medicare ,$10.57 ,100% of custom fee schedule,$74.61 ,58.75% of billed charges or 125% of CAH Medicare ,$6.18 ,100% AR Medicaid ,$59.69 ,47% of billed charges or 100% of CAH Medicare ,$8.24 ,100% AR Medicaid ,$59.69 ,47% of billed charges or 100% of CAH Medicare ,$7.01 ,90% for custom fee schedule,$59.69 ,47% of billed charges or 100% of CAH Medicare ,$59.69 ,47% of billed charges or 100% of CAH Medicare ,$6.18 ,$74.61 ,$127.00 
Outpatient Medical Services,LAB,87210,Wet Mount Smear,306,$46.00 ,$27.03 ,58.75% of billed charges or 125% of CAH Medicare ,$27.03 ,58.75% of billed charges or 125% of CAH Medicare ,$22.27 ,48.41% of billed charges or 125% of CAH Medicare ,$5.97 ,100% of custom fee schedule,$5.97 ,100% of custom fee schedule,$21.62 ,47% of billed charges or 100% of CAH Medicare ,$5.97 ,100% of custom fee schedule,$27.03 ,58.75% of billed charges or 125% of CAH Medicare ,$4.58 ,100% AR Medicaid ,$21.62 ,47% of billed charges or 100% of CAH Medicare ,$6.10 ,100% AR Medicaid ,$21.62 ,47% of billed charges or 100% of CAH Medicare ,$4.72 ,90% for custom fee schedule,$21.62 ,47% of billed charges or 100% of CAH Medicare ,$21.62 ,47% of billed charges or 100% of CAH Medicare ,$4.58 ,$27.03 ,$46.00 
Outpatient Medical Services,LAB,87252,Culture Viral,306,$354.09 ,$208.03 ,58.75% of billed charges or 125% of CAH Medicare ,$208.03 ,58.75% of billed charges or 125% of CAH Medicare ,$171.41 ,48.41% of billed charges or 125% of CAH Medicare ,$31.87 ,100% of custom fee schedule,$31.87 ,100% of custom fee schedule,$166.42 ,47% of billed charges or 100% of CAH Medicare ,$31.87 ,100% of custom fee schedule,$208.03 ,58.75% of billed charges or 125% of CAH Medicare ,$27.92 ,100% AR Medicaid ,$166.42 ,47% of billed charges or 100% of CAH Medicare ,$37.22 ,100% AR Medicaid ,$166.42 ,47% of billed charges or 100% of CAH Medicare ,$21.11 ,90% for custom fee schedule,$166.42 ,47% of billed charges or 100% of CAH Medicare ,$166.42 ,47% of billed charges or 100% of CAH Medicare ,$21.11 ,$208.03 ,$354.09 
Outpatient Medical Services,LAB,87324,C Difficile,306,$52.80 ,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$25.56 ,48.41% of billed charges or 125% of CAH Medicare ,$14.65 ,100% of custom fee schedule,$14.65 ,100% of custom fee schedule,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$14.65 ,100% of custom fee schedule,$31.02 ,58.75% of billed charges or 125% of CAH Medicare ,$9.65 ,100% AR Medicaid ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$12.87 ,100% AR Medicaid ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$9.70 ,90% for custom fee schedule,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$24.82 ,47% of billed charges or 100% of CAH Medicare ,$9.65 ,$31.02 ,$52.80 
Outpatient Medical Services,LAB,87338,H Pylori Stool AG Ela,306,$266.80 ,$156.75 ,58.75% of billed charges or 125% of CAH Medicare ,$156.75 ,58.75% of billed charges or 125% of CAH Medicare ,$129.16 ,48.41% of billed charges or 125% of CAH Medicare ,$17.58 ,100% of custom fee schedule,$17.58 ,100% of custom fee schedule,$125.40 ,47% of billed charges or 100% of CAH Medicare ,$17.58 ,100% of custom fee schedule,$156.75 ,58.75% of billed charges or 125% of CAH Medicare ,$4.59 ,100% AR Medicaid ,$125.40 ,47% of billed charges or 100% of CAH Medicare ,$6.12 ,100% AR Medicaid ,$125.40 ,47% of billed charges or 100% of CAH Medicare ,$11.65 ,90% for custom fee schedule,$125.40 ,47% of billed charges or 100% of CAH Medicare ,$125.40 ,47% of billed charges or 100% of CAH Medicare ,$4.59 ,$156.75 ,$266.80 
Outpatient Medical Services,LAB,87426,Covid-19 Antigen Test,300,$100.00 ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$48.41 ,48.41% of billed charges or 125% of CAH Medicare ,$45.23 ,100% of custom fee schedule,$45.23 ,100% of custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$45.23 ,100% of custom fee schedule,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$33.92 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$45.23 ,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$28.87 ,90% for custom fee schedule,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$28.87 ,$58.75 ,$100.00 
Outpatient Medical Services,LAB,87491,GC/Chlam Amp Probe,306,$282.00 ,$165.68 ,58.75% of billed charges or 125% of CAH Medicare ,$165.68 ,58.75% of billed charges or 125% of CAH Medicare ,$136.52 ,48.41% of billed charges or 125% of CAH Medicare ,$42.89 ,100% of custom fee schedule,$42.89 ,100% of custom fee schedule,$132.54 ,47% of billed charges or 100% of CAH Medicare ,$42.89 ,100% of custom fee schedule,$165.68 ,58.75% of billed charges or 125% of CAH Medicare ,$37.59 ,100% AR Medicaid ,$132.54 ,47% of billed charges or 100% of CAH Medicare ,$50.12 ,100% AR Medicaid ,$132.54 ,47% of billed charges or 100% of CAH Medicare ,$28.42 ,90% for custom fee schedule,$132.54 ,47% of billed charges or 100% of CAH Medicare ,$132.54 ,47% of billed charges or 100% of CAH Medicare ,$28.42 ,$165.68 ,$282.00 
Outpatient Medical Services,LAB,87502,ID Now Influenza A&B Molecular,300,$210.00 ,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$101.66 ,48.41% of billed charges or 125% of CAH Medicare ,$105.38 ,100% of custom fee schedule,$105.38 ,100% of custom fee schedule,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$105.38 ,100% of custom fee schedule,$123.38 ,58.75% of billed charges or 125% of CAH Medicare ,$89.81 ,100% AR Medicaid ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$119.75 ,100% AR Medicaid ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$77.60 ,90% for custom fee schedule,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$98.70 ,47% of billed charges or 100% of CAH Medicare ,$77.60 ,$123.38 ,$210.00 
Outpatient Medical Services,LAB,87634,"ID Now RSV, Molecular",300,$165.00 ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$79.88 ,48.41% of billed charges or 125% of CAH Medicare ,$85.79 ,100% of custom fee schedule,$85.79 ,100% of custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$85.79 ,100% of custom fee schedule,$96.94 ,58.75% of billed charges or 125% of CAH Medicare ,$65.00 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$86.66 ,100% AR Medicaid ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$56.86 ,90% for custom fee schedule,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$77.55 ,47% of billed charges or 100% of CAH Medicare ,$56.86 ,$96.94 ,$165.00 
Outpatient Medical Services,LAB,87635,Covid-19,300,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$77.00 ,100% of custom fee schedule,$77.00 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$77.00 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$41.56 ,90% for custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$41.56 ,$77.00 ,$130.00 
Outpatient Medical Services,LAB,87635,ID Now Covid 19 Molecular,300,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$77.00 ,100% of custom fee schedule,$77.00 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$77.00 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$41.56 ,90% for custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$41.56 ,$77.00 ,$130.00 
Outpatient Medical Services,LAB,87651,"ID Now Strep A 2, Molecular",300,$132.00 ,$77.55 ,58.75% of billed charges or 125% of CAH Medicare ,$77.55 ,58.75% of billed charges or 125% of CAH Medicare ,$63.90 ,48.41% of billed charges or 125% of CAH Medicare ,$42.89 ,100% of custom fee schedule,$42.89 ,100% of custom fee schedule,$62.04 ,47% of billed charges or 100% of CAH Medicare ,$42.89 ,100% of custom fee schedule,$77.55 ,58.75% of billed charges or 125% of CAH Medicare ,$37.59 ,100% AR Medicaid ,$62.04 ,47% of billed charges or 100% of CAH Medicare ,$50.12 ,100% AR Medicaid ,$62.04 ,47% of billed charges or 100% of CAH Medicare ,$28.42 ,90% for custom fee schedule,$62.04 ,47% of billed charges or 100% of CAH Medicare ,$62.04 ,47% of billed charges or 100% of CAH Medicare ,$28.42 ,$77.55 ,$132.00 
Outpatient Medical Services,LAB,87807,RSV Test,302,$136.40 ,$80.14 ,58.75% of billed charges or 125% of CAH Medicare ,$80.14 ,58.75% of billed charges or 125% of CAH Medicare ,$66.03 ,48.41% of billed charges or 125% of CAH Medicare ,$14.65 ,100% of custom fee schedule,$14.65 ,100% of custom fee schedule,$64.11 ,47% of billed charges or 100% of CAH Medicare ,$14.65 ,100% of custom fee schedule,$80.14 ,58.75% of billed charges or 125% of CAH Medicare ,$9.76 ,100% AR Medicaid ,$64.11 ,47% of billed charges or 100% of CAH Medicare ,$13.01 ,100% AR Medicaid ,$64.11 ,47% of billed charges or 100% of CAH Medicare ,$10.61 ,90% for custom fee schedule,$64.11 ,47% of billed charges or 100% of CAH Medicare ,$64.11 ,47% of billed charges or 100% of CAH Medicare ,$9.76 ,$80.14 ,$136.40 
Outpatient Medical Services,LAB,88272,Stool,300,$34.00 ,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$16.46 ,48.41% of billed charges or 125% of CAH Medicare ,$41.72 ,100% of custom fee schedule,$41.72 ,100% of custom fee schedule,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$41.72 ,100% of custom fee schedule,$19.98 ,58.75% of billed charges or 125% of CAH Medicare ,$28.67 ,100% AR Medicaid ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$38.23 ,100% AR Medicaid ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$32.97 ,90% for custom fee schedule,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$15.98 ,47% of billed charges or 100% of CAH Medicare ,$15.98 ,$41.72 ,$34.00 
Outpatient Medical Services,LAB,88312,Special Stains,310,$142.89 ,$83.95 ,58.75% of billed charges or 125% of CAH Medicare ,$83.95 ,58.75% of billed charges or 125% of CAH Medicare ,$69.17 ,48.41% of billed charges or 125% of CAH Medicare ,$45.01 ,100% of custom fee schedule,$45.01 ,100% of custom fee schedule,$67.16 ,47% of billed charges or 100% of CAH Medicare ,$45.01 ,100% of custom fee schedule,$83.95 ,58.75% of billed charges or 125% of CAH Medicare ,$26.95 ,100% AR Medicaid ,$67.16 ,47% of billed charges or 100% of CAH Medicare ,$35.93 ,100% AR Medicaid ,$67.16 ,47% of billed charges or 100% of CAH Medicare ,$41.11 ,90% for custom fee schedule,$67.16 ,47% of billed charges or 100% of CAH Medicare ,$67.16 ,47% of billed charges or 100% of CAH Medicare ,$26.95 ,$83.95 ,$142.89 
Outpatient Medical Services,LAB,89051,Cell Cnt-synovial W/Crystals,305,$146.70 ,$86.19 ,58.75% of billed charges or 125% of CAH Medicare ,$86.19 ,58.75% of billed charges or 125% of CAH Medicare ,$71.02 ,48.41% of billed charges or 125% of CAH Medicare ,$6.73 ,100% of custom fee schedule,$6.73 ,100% of custom fee schedule,$68.95 ,47% of billed charges or 100% of CAH Medicare ,$6.73 ,100% of custom fee schedule,$86.19 ,58.75% of billed charges or 125% of CAH Medicare ,$5.90 ,100% AR Medicaid ,$68.95 ,47% of billed charges or 100% of CAH Medicare ,$7.86 ,100% AR Medicaid ,$68.95 ,47% of billed charges or 100% of CAH Medicare ,$4.54 ,90% for custom fee schedule,$68.95 ,47% of billed charges or 100% of CAH Medicare ,$68.95 ,47% of billed charges or 100% of CAH Medicare ,$4.54 ,$86.19 ,$146.70 
Outpatient Medical Services,Speech Therapy,92507,Treatment Speech/Language Ind,440,$125.50 ,$73.73 ,58.75% of billed charges or 125% of CAH Medicare ,$73.73 ,58.75% of billed charges or 125% of CAH Medicare ,$60.75 ,48.41% of billed charges or 125% of CAH Medicare ,$80.72 ,100% of custom fee schedule,$80.72 ,100% of custom fee schedule,$58.99 ,47% of billed charges or 100% of CAH Medicare ,$80.72 ,100% of custom fee schedule,$73.73 ,58.75% of billed charges or 125% of CAH Medicare ,$21.76 ,100% AR Medicaid ,$58.99 ,47% of billed charges or 100% of CAH Medicare ,$21.76 ,100% AR Medicaid ,$58.99 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$58.99 ,47% of billed charges or 100% of CAH Medicare ,$58.99 ,47% of billed charges or 100% of CAH Medicare ,$21.76 ,$90.00 ,$125.50 
Outpatient Medical Services,Speech Therapy,92523,Medicaid Eval,440,$77.60 ,$45.59 ,58.75% of billed charges or 125% of CAH Medicare ,$45.59 ,58.75% of billed charges or 125% of CAH Medicare ,$37.57 ,48.41% of billed charges or 125% of CAH Medicare ,$196.67 ,100% of custom fee schedule,$196.67 ,100% of custom fee schedule,$36.47 ,47% of billed charges or 100% of CAH Medicare ,$196.67 ,100% of custom fee schedule,$45.59 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$36.47 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$36.47 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$36.47 ,47% of billed charges or 100% of CAH Medicare ,$36.47 ,47% of billed charges or 100% of CAH Medicare ,$36.47 ,$196.67 ,$77.60 
Outpatient Medical Services,Speech Therapy,92608,Medicaid Units,440,$34.75 ,$20.42 ,58.75% of billed charges or 125% of CAH Medicare ,$20.42 ,58.75% of billed charges or 125% of CAH Medicare ,$16.82 ,48.41% of billed charges or 125% of CAH Medicare ,$31.28 ,90% of total billed charges,$31.28 ,90% of total billed charges,$16.33 ,47% of billed charges or 100% of CAH Medicare ,$31.28 ,90% of total billed charges,$20.42 ,58.75% of billed charges or 125% of CAH Medicare ,$22.13 ,100% AR Medicaid ,$16.33 ,47% of billed charges or 100% of CAH Medicare ,$22.13 ,100% AR Medicaid ,$16.33 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$16.33 ,47% of billed charges or 100% of CAH Medicare ,$16.33 ,47% of billed charges or 100% of CAH Medicare ,$16.33 ,$90.00 ,$34.75 
Outpatient Medical Services,EKG,93005,EKG with 12 Leads Trac,730,$151.75 ,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$73.46 ,48.41% of billed charges or 125% of CAH Medicare ,$52.81 ,100% of custom fee schedule,$52.81 ,100% of custom fee schedule,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$52.81 ,100% of custom fee schedule,$89.15 ,58.75% of billed charges or 125% of CAH Medicare ,$17.00 ,100% AR Medicaid ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$17.00 ,100% AR Medicaid ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$71.32 ,47% of billed charges or 100% of CAH Medicare ,$17.00 ,$90.00 ,$151.75 
Outpatient Medical Services,ULTRASOUND,93880,U/S Duplex Cartoid,921,$762.00 ,$447.68 ,58.75% of billed charges or 125% of CAH Medicare ,$447.68 ,58.75% of billed charges or 125% of CAH Medicare ,$368.88 ,48.41% of billed charges or 125% of CAH Medicare ,$223.73 ,100% of custom fee schedule,$223.73 ,100% of custom fee schedule,$358.14 ,47% of billed charges or 100% of CAH Medicare ,$223.73 ,100% of custom fee schedule,$447.68 ,58.75% of billed charges or 125% of CAH Medicare ,$70.00 ,100% AR Medicaid ,$358.14 ,47% of billed charges or 100% of CAH Medicare ,$70.00 ,100% AR Medicaid ,$358.14 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$358.14 ,47% of billed charges or 100% of CAH Medicare ,$358.14 ,47% of billed charges or 100% of CAH Medicare ,$70.00 ,$447.68 ,$762.00 
Outpatient Medical Services,ULTRASOUND,93971,U/S Duplex Ext Vein Unilat,921,$537.00 ,$315.49 ,58.75% of billed charges or 125% of CAH Medicare ,$315.49 ,58.75% of billed charges or 125% of CAH Medicare ,$259.96 ,48.41% of billed charges or 125% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$107.60 ,100% of custom fee schedule,$252.39 ,47% of billed charges or 100% of CAH Medicare ,$107.60 ,100% of custom fee schedule,$315.49 ,58.75% of billed charges or 125% of CAH Medicare ,$73.00 ,100% AR Medicaid ,$252.39 ,47% of billed charges or 100% of CAH Medicare ,$73.00 ,100% AR Medicaid ,$252.39 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$252.39 ,47% of billed charges or 100% of CAH Medicare ,$252.39 ,47% of billed charges or 100% of CAH Medicare ,$73.00 ,$315.49 ,$537.00 
Outpatient Medical Services,Respiratory Therapy,94060,PFT Pre & Post Study,460,$409.00 ,$240.29 ,58.75% of billed charges or 125% of CAH Medicare ,$240.29 ,58.75% of billed charges or 125% of CAH Medicare ,$198.00 ,48.41% of billed charges or 125% of CAH Medicare ,$242.98 ,100% of custom fee schedule,$242.98 ,100% of custom fee schedule,$192.23 ,47% of billed charges or 100% of CAH Medicare ,$242.98 ,100% of custom fee schedule,$240.29 ,58.75% of billed charges or 125% of CAH Medicare ,$39.00 ,100% AR Medicaid ,$192.23 ,47% of billed charges or 100% of CAH Medicare ,$39.00 ,100% AR Medicaid ,$192.23 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$192.23 ,47% of billed charges or 100% of CAH Medicare ,$192.23 ,47% of billed charges or 100% of CAH Medicare ,$39.00 ,$242.98 ,$409.00 
Outpatient Medical Services,Respiratory Therapy,94150,PFT Pre Study,460,$224.00 ,$131.60 ,58.75% of billed charges or 125% of CAH Medicare ,$131.60 ,58.75% of billed charges or 125% of CAH Medicare ,$108.44 ,48.41% of billed charges or 125% of CAH Medicare ,$132.82 ,100% of custom fee schedule,$132.82 ,100% of custom fee schedule,$105.28 ,47% of billed charges or 100% of CAH Medicare ,$132.82 ,100% of custom fee schedule,$131.60 ,58.75% of billed charges or 125% of CAH Medicare ,$7.00 ,100% AR Medicaid ,$105.28 ,47% of billed charges or 100% of CAH Medicare ,$7.00 ,100% AR Medicaid ,$105.28 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$105.28 ,47% of billed charges or 100% of CAH Medicare ,$105.28 ,47% of billed charges or 100% of CAH Medicare ,$7.00 ,$132.82 ,$224.00 
Outpatient Medical Services,Respiratory Therapy,94618,Pulmonary Stress Testing,460,$167.15 ,$98.20 ,58.75% of billed charges or 125% of CAH Medicare ,$98.20 ,58.75% of billed charges or 125% of CAH Medicare ,$80.92 ,48.41% of billed charges or 125% of CAH Medicare ,$104.67 ,100% of custom fee schedule,$104.67 ,100% of custom fee schedule,$78.56 ,47% of billed charges or 100% of CAH Medicare ,$104.67 ,100% of custom fee schedule,$98.20 ,58.75% of billed charges or 125% of CAH Medicare ,$12.66 ,100% AR Medicaid ,$78.56 ,47% of billed charges or 100% of CAH Medicare ,$12.66 ,100% AR Medicaid ,$78.56 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$78.56 ,47% of billed charges or 100% of CAH Medicare ,$78.56 ,47% of billed charges or 100% of CAH Medicare ,$12.66 ,$104.67 ,$167.15 
Outpatient Medical Services,Respiratory Therapy,94640,Updraft Treatment,410,$298.00 ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$144.26 ,48.41% of billed charges or 125% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$176.61 ,100% of custom fee schedule,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,$176.61 ,$298.00 
Outpatient Medical Services,Respiratory Therapy,94640,MDI per treatment,410,$298.00 ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$144.26 ,48.41% of billed charges or 125% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$176.61 ,100% of custom fee schedule,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,$176.61 ,$298.00 
Outpatient Medical Services,Respiratory Therapy,94640,MDI setup,410,$298.00 ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$144.26 ,48.41% of billed charges or 125% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$176.61 ,100% of custom fee schedule,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$176.61 ,100% of custom fee schedule,$175.08 ,58.75% of billed charges or 125% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,100% AR Medicaid ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$140.06 ,47% of billed charges or 100% of CAH Medicare ,$6.00 ,$176.61 ,$298.00 
Outpatient Medical Services,Respiratory Therapy,94760,Pulse Ox Check,460,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$2.13 ,100% of custom fee schedule,$2.13 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$2.13 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$2.13 ,$90.00 ,$130.00 
Outpatient Medical Services,Physical Therapy,97001,Medicaid Eval,420,$100.00 ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,$48.41 ,48.41% of billed charges or 125% of CAH Medicare ,$90.00 ,90% of total billed charges,$90.00 ,90% of total billed charges,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,90% of total billed charges,$58.75 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$47.00 ,47% of billed charges or 100% of CAH Medicare ,$47.00 ,$150.00 ,$100.00 
Outpatient Medical Services,Physical Therapy,97010,Hot Pack/Cold Pack,420,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$6.18 ,100% of custom fee schedule,$6.18 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$6.18 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$6.18 ,$150.00 ,$130.00 
Outpatient Medical Services,Physical Therapy,97012,Traction,420,$96.00 ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,$46.47 ,48.41% of billed charges or 125% of CAH Medicare ,$15.43 ,100% of custom fee schedule,$15.43 ,100% of custom fee schedule,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$15.43 ,100% of custom fee schedule,$56.40 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$45.12 ,47% of billed charges or 100% of CAH Medicare ,$15.43 ,$150.00 ,$96.00 
Outpatient Medical Services,Physical Therapy,97018,Paraffin,420,$57.00 ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$27.59 ,48.41% of billed charges or 125% of CAH Medicare ,$5.84 ,100% of custom fee schedule,$5.84 ,100% of custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$5.84 ,100% of custom fee schedule,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$5.84 ,$150.00 ,$57.00 
Outpatient Medical Services,Physical Therapy,97032,E-stim Attended,420,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$15.09 ,100% of custom fee schedule,$15.09 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$15.09 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$15.09 ,$150.00 ,$130.00 
Outpatient Medical Services,Occurpational Therapy,97032,OT E-Stem,430,$58.30 ,$34.25 ,58.75% of billed charges or 125% of CAH Medicare ,$34.25 ,58.75% of billed charges or 125% of CAH Medicare ,$28.22 ,48.41% of billed charges or 125% of CAH Medicare ,$15.09 ,100% of custom fee schedule,$15.09 ,100% of custom fee schedule,$27.40 ,47% of billed charges or 100% of CAH Medicare ,$15.09 ,100% of custom fee schedule,$34.25 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$27.40 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$27.40 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$27.40 ,47% of billed charges or 100% of CAH Medicare ,$27.40 ,47% of billed charges or 100% of CAH Medicare ,$15.09 ,$90.00 ,$58.30 
Outpatient Medical Services,Physical Therapy,97035,Phonophoresis,420,$82.00 ,$48.18 ,58.75% of billed charges or 125% of CAH Medicare ,$48.18 ,58.75% of billed charges or 125% of CAH Medicare ,$39.70 ,48.41% of billed charges or 125% of CAH Medicare ,$14.57 ,100% of custom fee schedule,$14.57 ,100% of custom fee schedule,$38.54 ,47% of billed charges or 100% of CAH Medicare ,$14.57 ,100% of custom fee schedule,$48.18 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$38.54 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$38.54 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$38.54 ,47% of billed charges or 100% of CAH Medicare ,$38.54 ,47% of billed charges or 100% of CAH Medicare ,$14.57 ,$150.00 ,$82.00 
Outpatient Medical Services,Physical Therapy,97035,Ultrasound,420,$64.25 ,$37.75 ,58.75% of billed charges or 125% of CAH Medicare ,$37.75 ,58.75% of billed charges or 125% of CAH Medicare ,$31.10 ,48.41% of billed charges or 125% of CAH Medicare ,$14.57 ,100% of custom fee schedule,$14.57 ,100% of custom fee schedule,$30.20 ,47% of billed charges or 100% of CAH Medicare ,$14.57 ,100% of custom fee schedule,$37.75 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$30.20 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$30.20 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$30.20 ,47% of billed charges or 100% of CAH Medicare ,$30.20 ,47% of billed charges or 100% of CAH Medicare ,$14.57 ,$150.00 ,$64.25 
Outpatient Medical Services,Physical Therapy,97110,Ther-Ex 1-15 *,420,$144.00 ,$84.60 ,58.75% of billed charges or 125% of CAH Medicare ,$84.60 ,58.75% of billed charges or 125% of CAH Medicare ,$69.71 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$67.68 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$84.60 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$67.68 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$67.68 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$67.68 ,47% of billed charges or 100% of CAH Medicare ,$67.68 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$150.00 ,$144.00 
Outpatient Medical Services,Physical Therapy,97110,Ther Ex 16-30,420,$288.00 ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,$139.42 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$169.20 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$135.36 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$169.20 ,$288.00 
Outpatient Medical Services,Physical Therapy,97110,Ther Ex 31-45,420,$432.00 ,$253.80 ,58.75% of billed charges or 125% of CAH Medicare ,$253.80 ,58.75% of billed charges or 125% of CAH Medicare ,$209.13 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$203.04 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$253.80 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$203.04 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$203.04 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$203.04 ,47% of billed charges or 100% of CAH Medicare ,$203.04 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$253.80 ,$432.00 
Outpatient Medical Services,Physical Therapy,97110,Ther ex 46-60,420,$576.00 ,$338.40 ,58.75% of billed charges or 125% of CAH Medicare ,$338.40 ,58.75% of billed charges or 125% of CAH Medicare ,$278.84 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$270.72 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$338.40 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$270.72 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$270.72 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$270.72 ,47% of billed charges or 100% of CAH Medicare ,$270.72 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$338.40 ,$576.00 
Outpatient Medical Services,Physical Therapy,97110,Medicaid Ther Ex 1-15,420,$51.00 ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$24.69 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,$150.00 ,$51.00 
Outpatient Medical Services,Physical Therapy,97110,Medicaid Ther Ex 16-30,420,$112.00 ,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,$54.22 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$65.80 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$52.64 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$150.00 ,$112.00 
Outpatient Medical Services,Physical Therapy,97110,Medicaid Ther Ex 31-45,420,$152.00 ,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,$73.58 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$89.30 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$71.44 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$150.00 ,$152.00 
Outpatient Medical Services,Physical Therapy,97110,Medicaid Ther Ex 46-60,420,$184.00 ,$108.10 ,58.75% of billed charges or 125% of CAH Medicare ,$108.10 ,58.75% of billed charges or 125% of CAH Medicare ,$89.07 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$86.48 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$108.10 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$86.48 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$86.48 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$86.48 ,47% of billed charges or 100% of CAH Medicare ,$86.48 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$150.00 ,$184.00 
Outpatient Medical Services,Occurpational Therapy,97110,OT Hot Pack/Cold Pak,430,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$90.00 ,$130.00 
Outpatient Medical Services,Occurpational Therapy,97110,OT Ther Ex 1-15,430,$76.00 ,$44.65 ,58.75% of billed charges or 125% of CAH Medicare ,$44.65 ,58.75% of billed charges or 125% of CAH Medicare ,$36.79 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$35.72 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$44.65 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$35.72 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$35.72 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$35.72 ,47% of billed charges or 100% of CAH Medicare ,$35.72 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$90.00 ,$76.00 
Outpatient Medical Services,Occurpational Therapy,97110,OT Ther Ex 15-30,430,$183.90 ,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,$89.03 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$108.04 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$86.43 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$108.04 ,$183.90 
Outpatient Medical Services,Occurpational Therapy,97110,OT Ther Ex 31-45,430,$251.00 ,$147.46 ,58.75% of billed charges or 125% of CAH Medicare ,$147.46 ,58.75% of billed charges or 125% of CAH Medicare ,$121.51 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$117.97 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$147.46 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$117.97 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$117.97 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$117.97 ,47% of billed charges or 100% of CAH Medicare ,$117.97 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$147.46 ,$251.00 
Outpatient Medical Services,Occurpational Therapy,97110,Medicaid Ther Ex 1-15,430,$46.20 ,$27.14 ,58.75% of billed charges or 125% of CAH Medicare ,$27.14 ,58.75% of billed charges or 125% of CAH Medicare ,$22.37 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$21.71 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$27.14 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$21.71 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$21.71 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$21.71 ,47% of billed charges or 100% of CAH Medicare ,$21.71 ,47% of billed charges or 100% of CAH Medicare ,$21.71 ,$90.00 ,$46.20 
Outpatient Medical Services,Occurpational Therapy,97110,Medicaid Ther Ex 16-30,430,$101.65 ,$59.72 ,58.75% of billed charges or 125% of CAH Medicare ,$59.72 ,58.75% of billed charges or 125% of CAH Medicare ,$49.21 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$47.78 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$59.72 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$47.78 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$47.78 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$47.78 ,47% of billed charges or 100% of CAH Medicare ,$47.78 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$90.00 ,$101.65 
Outpatient Medical Services,Occurpational Therapy,97110,Medicaid Ther Ex 31-45,430,$137.50 ,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,$66.56 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$80.78 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$64.63 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$90.00 ,$137.50 
Outpatient Medical Services,Occurpational Therapy,97110,Medicaid Ther Ex 46-60,430,$167.00 ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,$80.84 ,48.41% of billed charges or 125% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$30.96 ,100% of custom fee schedule,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,100% of custom fee schedule,$98.11 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$78.49 ,47% of billed charges or 100% of CAH Medicare ,$30.96 ,$98.11 ,$167.00 
Outpatient Medical Services,Physical Therapy,97116,Gait Training,420,$103.00 ,$60.51 ,58.75% of billed charges or 125% of CAH Medicare ,$60.51 ,58.75% of billed charges or 125% of CAH Medicare ,$49.86 ,48.41% of billed charges or 125% of CAH Medicare ,$30.63 ,100% of custom fee schedule,$30.63 ,100% of custom fee schedule,$48.41 ,47% of billed charges or 100% of CAH Medicare ,$30.63 ,100% of custom fee schedule,$60.51 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$48.41 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$48.41 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$48.41 ,47% of billed charges or 100% of CAH Medicare ,$48.41 ,47% of billed charges or 100% of CAH Medicare ,$30.63 ,$150.00 ,$103.00 
Outpatient Medical Services,Physical Therapy,97124,Massage,420,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$29.30 ,100% of custom fee schedule,$29.30 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$29.30 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$29.30 ,$150.00 ,$130.00 
Outpatient Medical Services,Occurpational Therapy,97124,OT Massage,430,$57.00 ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,$27.59 ,48.41% of billed charges or 125% of CAH Medicare ,$29.30 ,100% of custom fee schedule,$29.30 ,100% of custom fee schedule,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$29.30 ,100% of custom fee schedule,$33.49 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$26.79 ,47% of billed charges or 100% of CAH Medicare ,$26.79 ,$90.00 ,$57.00 
Outpatient Medical Services,Occurpational Therapy,97140,OT Manual therapy,430,$56.10 ,$32.96 ,58.75% of billed charges or 125% of CAH Medicare ,$32.96 ,58.75% of billed charges or 125% of CAH Medicare ,$27.16 ,48.41% of billed charges or 125% of CAH Medicare ,$28.52 ,100% of custom fee schedule,$28.52 ,100% of custom fee schedule,$26.37 ,47% of billed charges or 100% of CAH Medicare ,$28.52 ,100% of custom fee schedule,$32.96 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$26.37 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$26.37 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$26.37 ,47% of billed charges or 100% of CAH Medicare ,$26.37 ,47% of billed charges or 100% of CAH Medicare ,$26.37 ,$90.00 ,$56.10 
Outpatient Medical Services,Physical Therapy,97161,PT Eval Low Complexity 20 Minutes,420,$169.00 ,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,$81.81 ,48.41% of billed charges or 125% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$86.30 ,100% of custom fee schedule,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$99.29 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$79.43 ,47% of billed charges or 100% of CAH Medicare ,$79.43 ,$150.00 ,$169.00 
Outpatient Medical Services,Physical Therapy,97162,PT Eval Mod. Complexity,420,$164.70 ,$96.76 ,58.75% of billed charges or 125% of CAH Medicare ,$96.76 ,58.75% of billed charges or 125% of CAH Medicare ,$79.73 ,48.41% of billed charges or 125% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$86.30 ,100% of custom fee schedule,$77.41 ,47% of billed charges or 100% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$96.76 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$77.41 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$77.41 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$77.41 ,47% of billed charges or 100% of CAH Medicare ,$77.41 ,47% of billed charges or 100% of CAH Medicare ,$77.41 ,$150.00 ,$164.70 
Outpatient Medical Services,Physical Therapy,97163,PT Eval High Complexity,420,$189.70 ,$111.45 ,58.75% of billed charges or 125% of CAH Medicare ,$111.45 ,58.75% of billed charges or 125% of CAH Medicare ,$91.83 ,48.41% of billed charges or 125% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$86.30 ,100% of custom fee schedule,$89.16 ,47% of billed charges or 100% of CAH Medicare ,$86.30 ,100% of custom fee schedule,$111.45 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$89.16 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$89.16 ,47% of billed charges or 100% of CAH Medicare ,$150.00 ,100% of case rate,$89.16 ,47% of billed charges or 100% of CAH Medicare ,$89.16 ,47% of billed charges or 100% of CAH Medicare ,$86.30 ,$150.00 ,$189.70 
Outpatient Medical Services,Occurpational Therapy,97165,OT Eval Low Complex,430,$126.00 ,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,$61.00 ,48.41% of billed charges or 125% of CAH Medicare ,$91.33 ,100% of custom fee schedule,$91.33 ,100% of custom fee schedule,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$91.33 ,100% of custom fee schedule,$74.03 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$59.22 ,47% of billed charges or 100% of CAH Medicare ,$59.22 ,$91.33 ,$126.00 
Outpatient Medical Services,Occurpational Therapy,97166,OT Eval Mod,430,$136.00 ,$79.90 ,58.75% of billed charges or 125% of CAH Medicare ,$79.90 ,58.75% of billed charges or 125% of CAH Medicare ,$65.84 ,48.41% of billed charges or 125% of CAH Medicare ,$90.99 ,100% of custom fee schedule,$90.99 ,100% of custom fee schedule,$63.92 ,47% of billed charges or 100% of CAH Medicare ,$90.99 ,100% of custom fee schedule,$79.90 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$63.92 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$63.92 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$63.92 ,47% of billed charges or 100% of CAH Medicare ,$63.92 ,47% of billed charges or 100% of CAH Medicare ,$63.92 ,$90.99 ,$136.00 
Outpatient Medical Services,Occurpational Therapy,97167,OT Eval High,430,$146.00 ,$85.78 ,58.75% of billed charges or 125% of CAH Medicare ,$85.78 ,58.75% of billed charges or 125% of CAH Medicare ,$70.68 ,48.41% of billed charges or 125% of CAH Medicare ,$90.99 ,100% of custom fee schedule,$90.99 ,100% of custom fee schedule,$68.62 ,47% of billed charges or 100% of CAH Medicare ,$90.99 ,100% of custom fee schedule,$85.78 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$68.62 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$68.62 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$68.62 ,47% of billed charges or 100% of CAH Medicare ,$68.62 ,47% of billed charges or 100% of CAH Medicare ,$68.62 ,$90.99 ,$146.00 
Outpatient Medical Services,WOUND CLINIC,99203,"Wound Care New patient office or other outpatient visit, typically 30 min",361,$457.00 ,$268.49 ,58.75% of billed charges or 125% of CAH Medicare ,$268.49 ,58.75% of billed charges or 125% of CAH Medicare ,$221.23 ,48.41% of billed charges or 125% of CAH Medicare ,$73.58 ,100% of custom fee schedule,$73.58 ,100% of custom fee schedule,$214.79 ,47% of billed charges or 100% of CAH Medicare ,$73.58 ,100% of custom fee schedule,$268.49 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$214.79 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$214.79 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$214.79 ,47% of billed charges or 100% of CAH Medicare ,$214.79 ,47% of billed charges or 100% of CAH Medicare ,$73.58 ,$268.49 ,$457.00 
Outpatient Medical Services,WOUND CLINIC,99204,"New patient office of other outpatient visit, typically 45 min",361,$603.75 ,$354.70 ,58.75% of billed charges or 125% of CAH Medicare ,$354.70 ,58.75% of billed charges or 125% of CAH Medicare ,$292.28 ,48.41% of billed charges or 125% of CAH Medicare ,$125.88 ,100% of custom fee schedule,$125.88 ,100% of custom fee schedule,$283.76 ,47% of billed charges or 100% of CAH Medicare ,$125.88 ,100% of custom fee schedule,$354.70 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$283.76 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$283.76 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$283.76 ,47% of billed charges or 100% of CAH Medicare ,$283.76 ,47% of billed charges or 100% of CAH Medicare ,$125.88 ,$354.70 ,$603.75 
Outpatient Medical Services,WOUND CLINIC,99205,"New patient office of other outpatient visit, typically 60 min",361,$664.10 ,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,$321.49 ,48.41% of billed charges or 125% of CAH Medicare ,$164.48 ,100% of custom fee schedule,$164.48 ,100% of custom fee schedule,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$164.48 ,100% of custom fee schedule,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$164.48 ,$390.16 ,$664.10 
Outpatient Medical Services,WOUND CLINIC,99205,New Patient Level 5,510,$664.10 ,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,$321.49 ,48.41% of billed charges or 125% of CAH Medicare ,$164.48 ,100% of custom fee schedule,$164.48 ,100% of custom fee schedule,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$164.48 ,100% of custom fee schedule,$390.16 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$312.13 ,47% of billed charges or 100% of CAH Medicare ,$164.48 ,$390.16 ,$664.10 
Outpatient Medical Services,WOUND CLINIC,99212,Established Patient Level 2,510,$437.00 ,$256.74 ,58.75% of billed charges or 125% of CAH Medicare ,$256.74 ,58.75% of billed charges or 125% of CAH Medicare ,$211.55 ,48.41% of billed charges or 125% of CAH Medicare ,$44.45 ,100% of custom fee schedule,$44.45 ,100% of custom fee schedule,$205.39 ,47% of billed charges or 100% of CAH Medicare ,$44.45 ,100% of custom fee schedule,$256.74 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$205.39 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$205.39 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$205.39 ,47% of billed charges or 100% of CAH Medicare ,$205.39 ,47% of billed charges or 100% of CAH Medicare ,$44.45 ,$256.74 ,$437.00 
Outpatient Medical Services,WOUND CLINIC,99213,Established Patient Level 3,510,$503.00 ,$295.51 ,58.75% of billed charges or 125% of CAH Medicare ,$295.51 ,58.75% of billed charges or 125% of CAH Medicare ,$243.50 ,48.41% of billed charges or 125% of CAH Medicare ,$74.12 ,100% of custom fee schedule,$74.12 ,100% of custom fee schedule,$236.41 ,47% of billed charges or 100% of CAH Medicare ,$74.12 ,100% of custom fee schedule,$295.51 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$236.41 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$236.41 ,47% of billed charges or 100% of CAH Medicare ,N/A,Not reimbursable per contract,$236.41 ,47% of billed charges or 100% of CAH Medicare ,$236.41 ,47% of billed charges or 100% of CAH Medicare ,$74.12 ,$295.51 ,$503.00 
Outpatient Medical Services,Respiratory Therapy,99406,Smoking - Tobacco Counsultation 3-10 min,410,$130.00 ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,$62.93 ,48.41% of billed charges or 125% of CAH Medicare ,$26.23 ,100% of custom fee schedule,$26.23 ,100% of custom fee schedule,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$26.23 ,100% of custom fee schedule,$76.38 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$61.10 ,47% of billed charges or 100% of CAH Medicare ,$26.23 ,$90.00 ,$130.00 
Outpatient Medical Services,LAB,G0103,PSA Screening,301,$163.35 ,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,$79.08 ,48.41% of billed charges or 125% of CAH Medicare ,$22.48 ,100% of custom fee schedule,$22.48 ,100% of custom fee schedule,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$22.48 ,100% of custom fee schedule,$95.97 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$15.64 ,90% for custom fee schedule,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$76.77 ,47% of billed charges or 100% of CAH Medicare ,$15.64 ,$95.97 ,$163.35 
Outpatient Medical Services,Speech Therapy,G0515,Dev Cogntive Skills EA 15 Min,440,$51.00 ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,$24.69 ,48.41% of billed charges or 125% of CAH Medicare ,$45.90 ,90% of total billed charges,$45.90 ,90% of total billed charges,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$45.90 ,90% of total billed charges,$29.96 ,58.75% of billed charges or 125% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,N/A,100% AR Medicaid ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$90.00 ,100% of case rate,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,47% of billed charges or 100% of CAH Medicare ,$23.97 ,$90.00 ,$51.00 
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,81003,Prostate specific antigen,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal ,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,73721,MRI scan of leg joint,610,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77067,"Mammography, screening, bilateral",403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Outpatient Medical Services,SLEEP STUDY,95810,Sleep study,920,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,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,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A