hospital_name,last_updated_on,version,location_name,hospital_address,license_number|DC,type_2_npi,"To the best of its knowledge and belief, this 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 in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,general_contract_provisions,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
MedStar National Rehab Hospital,    2025-12-30,3.0.0,MedStar Health Physical Therapy at Waugh Chapel Concussion Clinic,"2401 Brandermill BLVD, Gambrills, MD 21054-1691",HFD01-0014,1982453999,TRUE,John Rockwood,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,billing_class,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|min,standard_charge|max,additional_generic_notes,standard_charge|UnitedHealthcare Insurance Company|Optum VA Community Care|negotiated_dollar,standard_charge|UnitedHealthcare Insurance Company|Optum VA Community Care|negotiated_percentage,standard_charge|UnitedHealthcare Insurance Company|Optum VA Community Care|negotiated_algorithm,median_amount|UnitedHealthcare Insurance Company|Optum VA Community Care,10th_percentile|UnitedHealthcare Insurance Company|Optum VA Community Care,90th_percentile|UnitedHealthcare Insurance Company|Optum VA Community Care,count|UnitedHealthcare Insurance Company|Optum VA Community Care,standard_charge|UnitedHealthcare Insurance Company|Optum VA Community Care|methodology,additional_payer_notes|UnitedHealthcare Insurance Company|Optum VA Community Care,standard_charge|United Healthcare-Ovations|United Secure|negotiated_dollar,standard_charge|United Healthcare-Ovations|United Secure|negotiated_percentage,standard_charge|United Healthcare-Ovations|United Secure|negotiated_algorithm,median_amount|United Healthcare-Ovations|United Secure,10th_percentile|United Healthcare-Ovations|United Secure,90th_percentile|United Healthcare-Ovations|United Secure,count|United Healthcare-Ovations|United Secure,standard_charge|United Healthcare-Ovations|United Secure|methodology,additional_payer_notes|United Healthcare-Ovations|United Secure,standard_charge|United Healthcare|United Healthcare All Commercial|negotiated_dollar,standard_charge|United Healthcare|United Healthcare All Commercial|negotiated_percentage,standard_charge|United Healthcare|United Healthcare All Commercial|negotiated_algorithm,median_amount|United Healthcare|United Healthcare All Commercial,10th_percentile|United Healthcare|United Healthcare All Commercial,90th_percentile|United Healthcare|United Healthcare All Commercial,count|United Healthcare|United Healthcare All Commercial,standard_charge|United Healthcare|United Healthcare All Commercial|methodology,additional_payer_notes|United Healthcare|United Healthcare All Commercial,standard_charge|United Healthcare|UnitedHealthcare Community Plan of Maryland|negotiated_dollar,standard_charge|United Healthcare|UnitedHealthcare Community Plan of Maryland|negotiated_percentage,standard_charge|United Healthcare|UnitedHealthcare Community Plan of Maryland|negotiated_algorithm,median_amount|United Healthcare|UnitedHealthcare Community Plan of Maryland,10th_percentile|United Healthcare|UnitedHealthcare Community Plan of Maryland,90th_percentile|United Healthcare|UnitedHealthcare Community Plan of Maryland,count|United Healthcare|UnitedHealthcare Community Plan of Maryland,standard_charge|United Healthcare|UnitedHealthcare Community Plan of Maryland|methodology,additional_payer_notes|United Healthcare|UnitedHealthcare Community Plan of Maryland,standard_charge|United Healthcare|UHC Navigate/Core|negotiated_dollar,standard_charge|United Healthcare|UHC Navigate/Core|negotiated_percentage,standard_charge|United Healthcare|UHC Navigate/Core|negotiated_algorithm,median_amount|United Healthcare|UHC Navigate/Core,10th_percentile|United Healthcare|UHC Navigate/Core,90th_percentile|United Healthcare|UHC Navigate/Core,count|United Healthcare|UHC Navigate/Core,standard_charge|United Healthcare|UHC Navigate/Core|methodology,additional_payer_notes|United Healthcare|UHC Navigate/Core,standard_charge|United Healthcare|UHC Compass/ IEX|negotiated_dollar,standard_charge|United Healthcare|UHC Compass/ IEX|negotiated_percentage,standard_charge|United Healthcare|UHC Compass/ IEX|negotiated_algorithm,median_amount|United Healthcare|UHC Compass/ IEX,10th_percentile|United Healthcare|UHC Compass/ IEX,90th_percentile|United Healthcare|UHC Compass/ IEX,count|United Healthcare|UHC Compass/ IEX,standard_charge|United Healthcare|UHC Compass/ IEX|methodology,additional_payer_notes|United Healthcare|UHC Compass/ IEX,standard_charge|Tricare|Tricare|negotiated_dollar,standard_charge|Tricare|Tricare|negotiated_percentage,standard_charge|Tricare|Tricare|negotiated_algorithm,median_amount|Tricare|Tricare,10th_percentile|Tricare|Tricare,90th_percentile|Tricare|Tricare,count|Tricare|Tricare,standard_charge|Tricare|Tricare|methodology,additional_payer_notes|Tricare|Tricare,standard_charge|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS)|negotiated_dollar,standard_charge|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS)|negotiated_percentage,standard_charge|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS)|negotiated_algorithm,median_amount|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS),10th_percentile|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS),90th_percentile|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS),count|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS),standard_charge|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS)|methodology,additional_payer_notes|Private HealthCare Systems (PHCS)|Private HealthCare Systems (PHCS),standard_charge|Medstar Family Choice|Medstar Family Choice MD|negotiated_dollar,standard_charge|Medstar Family Choice|Medstar Family Choice MD|negotiated_percentage,standard_charge|Medstar Family Choice|Medstar Family Choice MD|negotiated_algorithm,median_amount|Medstar Family Choice|Medstar Family Choice MD,10th_percentile|Medstar Family Choice|Medstar Family Choice MD,90th_percentile|Medstar Family Choice|Medstar Family Choice MD,count|Medstar Family Choice|Medstar Family Choice MD,standard_charge|Medstar Family Choice|Medstar Family Choice MD|methodology,additional_payer_notes|Medstar Family Choice|Medstar Family Choice MD,standard_charge|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans|negotiated_dollar,standard_charge|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans|negotiated_percentage,standard_charge|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans|negotiated_algorithm,median_amount|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans,10th_percentile|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans,90th_percentile|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans,count|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans,standard_charge|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans|methodology,additional_payer_notes|Kaiser Permanente|All Kaiser Commercial Excluding Kaiser Permanente Signature and Signature Added Choice Plans,standard_charge|Kaiser Permanente|Kaiser Medicare Advantage|negotiated_dollar,standard_charge|Kaiser Permanente|Kaiser Medicare Advantage|negotiated_percentage,standard_charge|Kaiser Permanente|Kaiser Medicare Advantage|negotiated_algorithm,median_amount|Kaiser Permanente|Kaiser Medicare Advantage,10th_percentile|Kaiser Permanente|Kaiser Medicare Advantage,90th_percentile|Kaiser Permanente|Kaiser Medicare Advantage,count|Kaiser Permanente|Kaiser Medicare Advantage,standard_charge|Kaiser Permanente|Kaiser Medicare Advantage|methodology,additional_payer_notes|Kaiser Permanente|Kaiser Medicare Advantage,standard_charge|Kaiser Permanente|Kaiser MD MCO|negotiated_dollar,standard_charge|Kaiser Permanente|Kaiser MD MCO|negotiated_percentage,standard_charge|Kaiser Permanente|Kaiser MD MCO|negotiated_algorithm,median_amount|Kaiser Permanente|Kaiser MD MCO,10th_percentile|Kaiser Permanente|Kaiser MD MCO,90th_percentile|Kaiser Permanente|Kaiser MD MCO,count|Kaiser Permanente|Kaiser MD MCO,standard_charge|Kaiser Permanente|Kaiser MD MCO|methodology,additional_payer_notes|Kaiser Permanente|Kaiser MD MCO,standard_charge|JHHC|JHHC EHP and USFHP|negotiated_dollar,standard_charge|JHHC|JHHC EHP and USFHP|negotiated_percentage,standard_charge|JHHC|JHHC EHP and USFHP|negotiated_algorithm,median_amount|JHHC|JHHC EHP and USFHP,10th_percentile|JHHC|JHHC EHP and USFHP,90th_percentile|JHHC|JHHC EHP and USFHP,count|JHHC|JHHC EHP and USFHP,standard_charge|JHHC|JHHC EHP and USFHP|methodology,additional_payer_notes|JHHC|JHHC EHP and USFHP,standard_charge|Humana|Humana Medicare Advantage|negotiated_dollar,standard_charge|Humana|Humana Medicare Advantage|negotiated_percentage,standard_charge|Humana|Humana Medicare Advantage|negotiated_algorithm,median_amount|Humana|Humana Medicare Advantage,10th_percentile|Humana|Humana Medicare Advantage,90th_percentile|Humana|Humana Medicare Advantage,count|Humana|Humana Medicare Advantage,standard_charge|Humana|Humana Medicare Advantage|methodology,additional_payer_notes|Humana|Humana Medicare Advantage,standard_charge|HSCSN|HSCSN|negotiated_dollar,standard_charge|HSCSN|HSCSN|negotiated_percentage,standard_charge|HSCSN|HSCSN|negotiated_algorithm,median_amount|HSCSN|HSCSN,10th_percentile|HSCSN|HSCSN,90th_percentile|HSCSN|HSCSN,count|HSCSN|HSCSN,standard_charge|HSCSN|HSCSN|methodology,additional_payer_notes|HSCSN|HSCSN,standard_charge|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO|negotiated_dollar,standard_charge|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO|negotiated_percentage,standard_charge|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO|negotiated_algorithm,median_amount|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO,10th_percentile|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO,90th_percentile|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO,count|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO,standard_charge|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO|methodology,additional_payer_notes|Cigna HealthCare MidAtlantic Inc|Cigna All HMO and PPO,standard_charge|Health Care Service Corporation | Health Care Service Corporation|negotiated_dollar,standard_charge|Health Care Service Corporation | Health Care Service Corporation|negotiated_percentage,standard_charge|Health Care Service Corporation | Health Care Service Corporation|negotiated_algorithm,median_amount|Health Care Service Corporation | Health Care Service Corporation,10th_percentile|Health Care Service Corporation | Health Care Service Corporation,90th_percentile|Health Care Service Corporation | Health Care Service Corporation,count|Health Care Service Corporation | Health Care Service Corporation,standard_charge|Health Care Service Corporation | Health Care Service Corporation|methodology,additional_payer_notes|Health Care Service Corporation | Health Care Service Corporation,standard_charge|CareFirst Blue Choice Inc|All Carefirst PPO Plans|negotiated_dollar,standard_charge|CareFirst Blue Choice Inc|All Carefirst PPO Plans|negotiated_percentage,standard_charge|CareFirst Blue Choice Inc|All Carefirst PPO Plans|negotiated_algorithm,median_amount|CareFirst Blue Choice Inc|All Carefirst PPO Plans,10th_percentile|CareFirst Blue Choice Inc|All Carefirst PPO Plans,90th_percentile|CareFirst Blue Choice Inc|All Carefirst PPO Plans,count|CareFirst Blue Choice Inc|All Carefirst PPO Plans,standard_charge|CareFirst Blue Choice Inc|All Carefirst PPO Plans|methodology,additional_payer_notes|CareFirst Blue Choice Inc|All Carefirst PPO Plans,standard_charge|CareFirst Advantage Inc|CareFirst Medicare Advantage|negotiated_dollar,standard_charge|CareFirst Advantage Inc|CareFirst Medicare Advantage|negotiated_percentage,standard_charge|CareFirst Advantage Inc|CareFirst Medicare Advantage|negotiated_algorithm,median_amount|CareFirst Advantage Inc|CareFirst Medicare Advantage,10th_percentile|CareFirst Advantage Inc|CareFirst Medicare Advantage,90th_percentile|CareFirst Advantage Inc|CareFirst Medicare Advantage,count|CareFirst Advantage Inc|CareFirst Medicare Advantage,standard_charge|CareFirst Advantage Inc|CareFirst Medicare Advantage|methodology,additional_payer_notes|CareFirst Advantage Inc|CareFirst Medicare Advantage,standard_charge|CareFirst Blue Choice Inc|All Carefirst HMO Plans|negotiated_dollar,standard_charge|CareFirst Blue Choice Inc|All Carefirst HMO Plans|negotiated_percentage,standard_charge|CareFirst Blue Choice Inc|All Carefirst HMO Plans|negotiated_algorithm,median_amount|CareFirst Blue Choice Inc|All Carefirst HMO Plans,10th_percentile|CareFirst Blue Choice Inc|All Carefirst HMO Plans,90th_percentile|CareFirst Blue Choice Inc|All Carefirst HMO Plans,count|CareFirst Blue Choice Inc|All Carefirst HMO Plans,standard_charge|CareFirst Blue Choice Inc|All Carefirst HMO Plans|methodology,additional_payer_notes|CareFirst Blue Choice Inc|All Carefirst HMO Plans,standard_charge|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans|negotiated_dollar,standard_charge|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans|negotiated_percentage,standard_charge|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans|negotiated_algorithm,median_amount|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans,10th_percentile|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans,90th_percentile|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans,count|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans,standard_charge|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans|methodology,additional_payer_notes|Aetna US HealthCare Inc|Aetna All HMO and PPO Plans,standard_charge|Aetna Medicare|Aetna Medicare|negotiated_dollar,standard_charge|Aetna Medicare|Aetna Medicare|negotiated_percentage,standard_charge|Aetna Medicare|Aetna Medicare|negotiated_algorithm,median_amount|Aetna Medicare|Aetna Medicare,10th_percentile|Aetna Medicare|Aetna Medicare,90th_percentile|Aetna Medicare|Aetna Medicare,count|Aetna Medicare|Aetna Medicare,standard_charge|Aetna Medicare|Aetna Medicare|methodology,additional_payer_notes|Aetna Medicare|Aetna Medicare,standard_charge|Aetna Better Health|Aetna Better Health of Maryland|negotiated_dollar,standard_charge|Aetna Better Health|Aetna Better Health of Maryland|negotiated_percentage,standard_charge|Aetna Better Health|Aetna Better Health of Maryland|negotiated_algorithm,median_amount|Aetna Better Health|Aetna Better Health of Maryland,10th_percentile|Aetna Better Health|Aetna Better Health of Maryland,90th_percentile|Aetna Better Health|Aetna Better Health of Maryland,count|Aetna Better Health|Aetna Better Health of Maryland,standard_charge|Aetna Better Health|Aetna Better Health of Maryland|methodology,additional_payer_notes|Aetna Better Health|Aetna Better Health of Maryland,standard_charge|PFC|PFC|negotiated_dollar,standard_charge|PFC|PFC|negotiated_percentage,standard_charge|PFC|PFC|negotiated_algorithm,median_amount|PFC|PFC,10th_percentile|PFC|PFC,90th_percentile|PFC|PFC,count|PFC|PFC,standard_charge|PFC|PFC|methodology,additional_payer_notes|PFC|PFC
PT NDL INS W/O NJX 1 OR 2 MUSC,96000013,CDM,0420,RC,20560,CPT,11,Local,GP  ,outpatient,professional,,,137,150,23.03,116.45,cash pricing is a case rate for all services provided during a visit,26.05,,,,,,,fee schedule,,26.15,,,,,,,fee schedule,,71.64,,,,,,,fee schedule,Payment capped at billed charges,23.03,,,,,,,fee schedule,,63.76,,,,,,,fee schedule,Payment capped at billed charges,53.01,,,,,,,fee schedule,Payment capped at billed charges,109.6,,,,,,,fee schedule,payment capped at 80% of billed charges,116.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,34.58,,,,,,,fee schedule,Payment capped at billed charges,28.82,,,,,,,fee schedule,Payment capped at billed charges,26.22,,,,,,,fee schedule,Payment capped at billed charges,26.05,,,,,,,fee schedule,Payment capped at billed charges,29.28,,,,,,,fee schedule,Payment capped at billed charges,68.5,,,,,,,fee schedule,,73.63,,,,,,,fee schedule,Payment capped at billed charges,26.4,,,,,,,fee schedule,Payment capped at billed charges,60.11,,,,,,,fee schedule,Payment capped at billed charges,25.63,,,,,,,fee schedule,Payment capped at billed charges,54.1,,,,,,,fee schedule,Payment capped at billed charges,63.2836547,,,,,,,fee schedule,Payment capped at billed charges,26.4,,,,,,,fee schedule,Payment capped at billed charges,25.08,,,,,,,fee schedule,,89.05,,,,,,,percent of total billed charges,
PT NDL INSJ W/O NJX 3  MUSC,96000021,CDM,0420,RC,20561,CPT,11,Local,GP  ,outpatient,professional,,,137,150,34.25,116.45,cash pricing is a case rate for all services provided during a visit,38.03,,,,,,,fee schedule,,38.17,,,,,,,fee schedule,,103.04,,,,,,,fee schedule,Payment capped at billed charges,34.25,,,,,,,fee schedule,,91.71,,,,,,,fee schedule,Payment capped at billed charges,76.25,,,,,,,fee schedule,Payment capped at billed charges,109.6,,,,,,,fee schedule,payment capped at 80% of billed charges,116.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,50.44,,,,,,,fee schedule,Payment capped at billed charges,42.03,,,,,,,fee schedule,Payment capped at billed charges,39,,,,,,,fee schedule,Payment capped at billed charges,38.03,,,,,,,fee schedule,Payment capped at billed charges,42.71,,,,,,,fee schedule,Payment capped at billed charges,68.5,,,,,,,fee schedule,,104.39,,,,,,,fee schedule,Payment capped at billed charges,38.54,,,,,,,fee schedule,Payment capped at billed charges,85.22,,,,,,,fee schedule,Payment capped at billed charges,37.42,,,,,,,fee schedule,Payment capped at billed charges,76.7,,,,,,,fee schedule,Payment capped at billed charges,92.07255257,,,,,,,fee schedule,Payment capped at billed charges,38.54,,,,,,,fee schedule,Payment capped at billed charges,37.3,,,,,,,fee schedule,,89.05,,,,,,,percent of total billed charges,
PT BIOFEEDBACK TRAINING,96000039,CDM,0420,RC,90901,CPT,11,Local,GP  ,outpatient,professional,,,141,150,28.82,120.85,cash pricing is a case rate for all services provided during a visit,41.92,,,,,,,fee schedule,,42.07,,,,,,,fee schedule,,120.85,,,,,,,fee schedule,Payment capped at billed charges,28.82,,,,,,,fee schedule,,107.56,,,,,,,fee schedule,Payment capped at billed charges,89.43,,,,,,,fee schedule,Payment capped at billed charges,40.66,,,,,,,fee schedule,payment capped at 80% of billed charges,119.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,56.09,,,,,,,fee schedule,Payment capped at billed charges,46.73,,,,,,,fee schedule,Payment capped at billed charges,32.81,,,,,,,fee schedule,Payment capped at billed charges,41.92,,,,,,,fee schedule,Payment capped at billed charges,47.49,,,,,,,fee schedule,Payment capped at billed charges,70.5,,,,,,,fee schedule,,120.5,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,80.01,,,,,,,fee schedule,Payment capped at billed charges,41.25,,,,,,,fee schedule,Payment capped at billed charges,72,,,,,,,fee schedule,Payment capped at billed charges,100.638681,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,31.38,,,,,,,fee schedule,,91.65,,,,,,,percent of total billed charges,
PT BIOFEEDBACK INCONT 1ST15MIN,96000047,CDM,0420,RC,90912,CPT,11,Local,GP  ,outpatient,professional,,,237,150,70.53,237,cash pricing is a case rate for all services provided during a visit,82.3,,,,,,,fee schedule,,82.6,,,,,,,fee schedule,,236.66,,,,,,,fee schedule,Payment capped at billed charges,70.53,,,,,,,fee schedule,,210.63,,,,,,,fee schedule,Payment capped at billed charges,175.13,,,,,,,fee schedule,Payment capped at billed charges,79.83,,,,,,,fee schedule,payment capped at 80% of billed charges,201.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,109.84,,,,,,,fee schedule,Payment capped at billed charges,91.52,,,,,,,fee schedule,Payment capped at billed charges,80.3,,,,,,,fee schedule,Payment capped at billed charges,82.3,,,,,,,fee schedule,Payment capped at billed charges,93.01,,,,,,,fee schedule,Payment capped at billed charges,118.5,,,,,,,fee schedule,,237,,,,,,,fee schedule,Payment capped at billed charges,83.41,,,,,,,fee schedule,Payment capped at billed charges,150.27,,,,,,,fee schedule,Payment capped at billed charges,80.98,,,,,,,fee schedule,Payment capped at billed charges,135.24,,,,,,,fee schedule,Payment capped at billed charges,197.8747075,,,,,,,fee schedule,Payment capped at billed charges,83.41,,,,,,,fee schedule,Payment capped at billed charges,76.81,,,,,,,fee schedule,,154.05,,,,,,,percent of total billed charges,
PT BIOFEEDBACK INCONT ADD15MIN,96000054,CDM,0420,RC,90913,CPT,11,Local,GP  ,outpatient,professional,,,91,150,28.38,91,cash pricing is a case rate for all services provided during a visit,33.11,,,,,,,fee schedule,,33.23,,,,,,,fee schedule,,91,,,,,,,fee schedule,Payment capped at billed charges,28.38,,,,,,,fee schedule,,82.06,,,,,,,fee schedule,Payment capped at billed charges,68.23,,,,,,,fee schedule,Payment capped at billed charges,32.12,,,,,,,fee schedule,payment capped at 80% of billed charges,77.35,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,43.64,,,,,,,fee schedule,Payment capped at billed charges,36.36,,,,,,,fee schedule,Payment capped at billed charges,32.32,,,,,,,fee schedule,Payment capped at billed charges,33.11,,,,,,,fee schedule,Payment capped at billed charges,36.95,,,,,,,fee schedule,Payment capped at billed charges,45.5,,,,,,,fee schedule,,91,,,,,,,fee schedule,Payment capped at billed charges,33.56,,,,,,,fee schedule,Payment capped at billed charges,59.61,,,,,,,fee schedule,Payment capped at billed charges,32.58,,,,,,,fee schedule,Payment capped at billed charges,53.66,,,,,,,fee schedule,Payment capped at billed charges,78.88378988,,,,,,,fee schedule,Payment capped at billed charges,33.56,,,,,,,fee schedule,Payment capped at billed charges,30.91,,,,,,,fee schedule,,59.15,,,,,,,percent of total billed charges,
PT CANALITH REPOSITIONING,96000062,CDM,0420,RC,95992,CPT,11,Local,GP  ,outpatient,professional,,,124,150,33.84,120.98,cash pricing is a case rate for all services provided during a visit,43.1,,,,,,,fee schedule,,43.26,,,,,,,fee schedule,,120.98,,,,,,,fee schedule,Payment capped at billed charges,33.84,,,,,,,fee schedule,,107.67,,,,,,,fee schedule,Payment capped at billed charges,89.53,,,,,,,fee schedule,Payment capped at billed charges,41.81,,,,,,,fee schedule,payment capped at 80% of billed charges,105.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,56.63,,,,,,,fee schedule,Payment capped at billed charges,47.19,,,,,,,fee schedule,Payment capped at billed charges,38.53,,,,,,,fee schedule,Payment capped at billed charges,43.1,,,,,,,fee schedule,Payment capped at billed charges,47.95,,,,,,,fee schedule,Payment capped at billed charges,38.37,,,,,,,fee schedule,,100.95,,,,,,,fee schedule,Payment capped at billed charges,43.68,,,,,,,fee schedule,Payment capped at billed charges,89.32,,,,,,,fee schedule,Payment capped at billed charges,42.41,,,,,,,fee schedule,Payment capped at billed charges,80.39,,,,,,,fee schedule,Payment capped at billed charges,105.3818453,,,,,,,fee schedule,Payment capped at billed charges,43.68,,,,,,,fee schedule,Payment capped at billed charges,36.85,,,,,,,fee schedule,,80.6,,,,,,,percent of total billed charges,
PT DEVEL TEST ADMIN 1ST HR,96000070,CDM,0420,RC,96112,CPT,11,Local,GP  ,outpatient,professional,,,378,150,90,354.81,cash pricing is a case rate for all services provided during a visit,133.43,,,,,,,fee schedule,,133.92,,,,,,,fee schedule,,350.03,,,,,,,fee schedule,Payment capped at billed charges,116.84,,,,,,,fee schedule,,311.53,,,,,,,fee schedule,Payment capped at billed charges,259.02,,,,,,,fee schedule,Payment capped at billed charges,129.43,,,,,,,fee schedule,payment capped at 80% of billed charges,321.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,173.89,,,,,,,fee schedule,Payment capped at billed charges,144.89,,,,,,,fee schedule,Payment capped at billed charges,133.03,,,,,,,fee schedule,Payment capped at billed charges,133.43,,,,,,,fee schedule,Payment capped at billed charges,147.24,,,,,,,fee schedule,Payment capped at billed charges,117.79,,,,,,,fee schedule,,354.81,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,261.71,,,,,,,fee schedule,Payment capped at billed charges,131.3,,,,,,,fee schedule,Payment capped at billed charges,235.55,,,,,,,fee schedule,Payment capped at billed charges,304.0647219,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,127.25,,,,,,,fee schedule,,245.7,,,,,,,percent of total billed charges,
PT DEVEL TEST ADMIN EA ADD 30M,96000088,CDM,0420,RC,96113,CPT,11,Local,GP  ,outpatient,professional,,,169,150,49.16,169,cash pricing is a case rate for all services provided during a visit,55.66,,,,,,,fee schedule,,55.86,,,,,,,fee schedule,,169,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,151.55,,,,,,,fee schedule,Payment capped at billed charges,126.01,,,,,,,fee schedule,Payment capped at billed charges,53.99,,,,,,,fee schedule,payment capped at 80% of billed charges,143.65,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,72.56,,,,,,,fee schedule,Payment capped at billed charges,60.46,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,55.66,,,,,,,fee schedule,Payment capped at billed charges,61.45,,,,,,,fee schedule,Payment capped at billed charges,49.16,,,,,,,fee schedule,,168.24,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,123.18,,,,,,,fee schedule,Payment capped at billed charges,54.77,,,,,,,fee schedule,Payment capped at billed charges,110.86,,,,,,,fee schedule,Payment capped at billed charges,144.044931,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,109.85,,,,,,,percent of total billed charges,
PT TRACTION MECHANICAL,96000096,CDM,0420,RC,97012,CPT,11,Local,GP  ,outpatient,professional,,,41,150,12.92,90,cash pricing is a case rate for all services provided during a visit,14.95,,,,,,,fee schedule,,15.01,,,,,,,fee schedule,,35.24,,,,,,,fee schedule,Payment capped at billed charges,12.92,,,,,,,fee schedule,,31.36,,,,,,,fee schedule,Payment capped at billed charges,26.08,,,,,,,fee schedule,Payment capped at billed charges,14.5,,,,,,,fee schedule,payment capped at 80% of billed charges,34.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.68,,,,,,,fee schedule,Payment capped at billed charges,16.4,,,,,,,fee schedule,Payment capped at billed charges,14.57,,,,,,,fee schedule,Payment capped at billed charges,14.95,,,,,,,fee schedule,Payment capped at billed charges,16.66,,,,,,,fee schedule,Payment capped at billed charges,13.34,,,,,,,fee schedule,,33.06,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,24.03,,,,,,,fee schedule,Payment capped at billed charges,14.71,,,,,,,fee schedule,Payment capped at billed charges,21.64,,,,,,,fee schedule,Payment capped at billed charges,35.06959218,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,13.94,,,,,,,fee schedule,,26.65,,,,,,,percent of total billed charges,
PT E-STIM UNATT,96000104,CDM,0420,RC,97014,CPT,11,Local,GP  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,12.99,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
PT E-STIM WOUND CARE UNATTEND,96000112,CDM,0420,RC,97014,CPT,11,Local,GP  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,12.99,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
PT ELEC STIM UNATTENDED,96000120,CDM,0420,RC,97014,CPT,11,Local,GP  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,12.99,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
PT VASOPNEUMATIC DEVICES,96000138,CDM,0420,RC,97016,CPT,11,Local,GP  ,outpatient,professional,,,49,150,10.99,90,cash pricing is a case rate for all services provided during a visit,12.29,,,,,,,fee schedule,,12.34,,,,,,,fee schedule,,29.66,,,,,,,fee schedule,Payment capped at billed charges,13.19,,,,,,,fee schedule,,26.4,,,,,,,fee schedule,Payment capped at billed charges,21.95,,,,,,,fee schedule,Payment capped at billed charges,11.92,,,,,,,fee schedule,payment capped at 80% of billed charges,41.65,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,16.23,,,,,,,fee schedule,Payment capped at billed charges,13.52,,,,,,,fee schedule,Payment capped at billed charges,14.13,,,,,,,fee schedule,Payment capped at billed charges,12.29,,,,,,,fee schedule,Payment capped at billed charges,13.74,,,,,,,fee schedule,Payment capped at billed charges,10.99,,,,,,,fee schedule,,27.92,,,,,,,fee schedule,Payment capped at billed charges,12.46,,,,,,,fee schedule,Payment capped at billed charges,34.95,,,,,,,fee schedule,Payment capped at billed charges,12.09,,,,,,,fee schedule,Payment capped at billed charges,31.6,,,,,,,fee schedule,Payment capped at billed charges,28.69154672,,,,,,,fee schedule,Payment capped at billed charges,12.46,,,,,,,fee schedule,Payment capped at billed charges,13.52,,,,,,,fee schedule,,31.85,,,,,,,percent of total billed charges,
PT PARAFFIN BATH,96000146,CDM,0420,RC,97018,CPT,11,Local,GP  ,outpatient,professional,,,50,150,5.93,90,cash pricing is a case rate for all services provided during a visit,6.59,,,,,,,fee schedule,,6.61,,,,,,,fee schedule,,,,,,,,,,service not payable,6.51,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,6.39,,,,,,,fee schedule,payment capped at 80% of billed charges,42.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,8.75,,,,,,,fee schedule,Payment capped at billed charges,7.29,,,,,,,fee schedule,Payment capped at billed charges,6.97,,,,,,,fee schedule,Payment capped at billed charges,6.59,,,,,,,fee schedule,Payment capped at billed charges,7.41,,,,,,,fee schedule,Payment capped at billed charges,5.93,,,,,,,fee schedule,,13.92,,,,,,,fee schedule,Payment capped at billed charges,6.68,,,,,,,fee schedule,Payment capped at billed charges,31.12,,,,,,,fee schedule,Payment capped at billed charges,6.48,,,,,,,fee schedule,Payment capped at billed charges,27.77,,,,,,,fee schedule,Payment capped at billed charges,14.15841103,,,,,,,fee schedule,Payment capped at billed charges,6.68,,,,,,,fee schedule,Payment capped at billed charges,6.67,,,,,,,fee schedule,,32.5,,,,,,,percent of total billed charges,
PT MODALTY WHIRLPOOL,96000153,CDM,0420,RC,97022,CPT,11,Local,GP  ,outpatient,professional,,,62,150,14.92,90,cash pricing is a case rate for all services provided during a visit,16.49,,,,,,,fee schedule,,16.55,,,,,,,fee schedule,,44.16,,,,,,,fee schedule,Payment capped at billed charges,19.19,,,,,,,fee schedule,,39.3,,,,,,,fee schedule,Payment capped at billed charges,32.68,,,,,,,fee schedule,Payment capped at billed charges,16,,,,,,,fee schedule,payment capped at 80% of billed charges,52.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,22.02,,,,,,,fee schedule,Payment capped at billed charges,18.35,,,,,,,fee schedule,Payment capped at billed charges,20.76,,,,,,,fee schedule,Payment capped at billed charges,16.49,,,,,,,fee schedule,Payment capped at billed charges,18.65,,,,,,,fee schedule,Payment capped at billed charges,14.92,,,,,,,fee schedule,,41.82,,,,,,,fee schedule,Payment capped at billed charges,16.71,,,,,,,fee schedule,Payment capped at billed charges,32.56,,,,,,,fee schedule,Payment capped at billed charges,16.23,,,,,,,fee schedule,Payment capped at billed charges,29.68,,,,,,,fee schedule,Payment capped at billed charges,42.17777125,,,,,,,fee schedule,Payment capped at billed charges,16.71,,,,,,,fee schedule,Payment capped at billed charges,19.86,,,,,,,fee schedule,,40.3,,,,,,,percent of total billed charges,
PT E-STIM ATTENDED PER 15 MIN,96000161,CDM,0420,RC,97032,CPT,11,Local,GP  ,outpatient,professional,,,48,150,13.34,90,cash pricing is a case rate for all services provided during a visit,14.95,,,,,,,fee schedule,,15.01,,,,,,,fee schedule,,36.15,,,,,,,fee schedule,Payment capped at billed charges,15.26,,,,,,,fee schedule,,32.17,,,,,,,fee schedule,Payment capped at billed charges,26.75,,,,,,,fee schedule,Payment capped at billed charges,14.5,,,,,,,fee schedule,payment capped at 80% of billed charges,40.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.68,,,,,,,fee schedule,Payment capped at billed charges,16.4,,,,,,,fee schedule,Payment capped at billed charges,17.2,,,,,,,fee schedule,Payment capped at billed charges,14.95,,,,,,,fee schedule,Payment capped at billed charges,16.66,,,,,,,fee schedule,Payment capped at billed charges,13.34,,,,,,,fee schedule,,33.93,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,21.77,,,,,,,fee schedule,Payment capped at billed charges,14.71,,,,,,,fee schedule,Payment capped at billed charges,19.61,,,,,,,fee schedule,Payment capped at billed charges,35.06959218,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,16.46,,,,,,,fee schedule,,31.2,,,,,,,percent of total billed charges,
PT IONTOPHORESIS EACH 15 M,96000179,CDM,0420,RC,97033,CPT,11,Local,GP  ,outpatient,professional,,,59,150,17.83,90,cash pricing is a case rate for all services provided during a visit,19.81,,,,,,,fee schedule,,19.88,,,,,,,fee schedule,,49.56,,,,,,,fee schedule,Payment capped at billed charges,17.83,,,,,,,fee schedule,,44.11,,,,,,,fee schedule,Payment capped at billed charges,36.67,,,,,,,fee schedule,Payment capped at billed charges,19.22,,,,,,,fee schedule,payment capped at 80% of billed charges,50.15,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,26.31,,,,,,,fee schedule,Payment capped at billed charges,21.92,,,,,,,fee schedule,Payment capped at billed charges,20.1,,,,,,,fee schedule,Payment capped at billed charges,19.81,,,,,,,fee schedule,Payment capped at billed charges,22.28,,,,,,,fee schedule,Payment capped at billed charges,17.83,,,,,,,fee schedule,,46.72,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,Payment capped at billed charges,31.54,,,,,,,fee schedule,Payment capped at billed charges,19.49,,,,,,,fee schedule,Payment capped at billed charges,28.38,,,,,,,fee schedule,Payment capped at billed charges,48.45846557,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,Payment capped at billed charges,19.23,,,,,,,fee schedule,,38.35,,,,,,,percent of total billed charges,
PT CONTRAST BATH 1-15MIN,96000187,CDM,0420,RC,97034,CPT,11,Local,GP  ,outpatient,professional,,,45,150,12.83,90,cash pricing is a case rate for all services provided during a visit,14.33,,,,,,,fee schedule,,14.38,,,,,,,fee schedule,,35.65,,,,,,,fee schedule,Payment capped at billed charges,14.45,,,,,,,fee schedule,,31.73,,,,,,,fee schedule,Payment capped at billed charges,26.38,,,,,,,fee schedule,Payment capped at billed charges,13.9,,,,,,,fee schedule,payment capped at 80% of billed charges,38.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,18.93,,,,,,,fee schedule,Payment capped at billed charges,15.78,,,,,,,fee schedule,Payment capped at billed charges,16.3,,,,,,,fee schedule,Payment capped at billed charges,14.33,,,,,,,fee schedule,Payment capped at billed charges,16.03,,,,,,,fee schedule,Payment capped at billed charges,12.83,,,,,,,fee schedule,,34.43,,,,,,,fee schedule,Payment capped at billed charges,14.52,,,,,,,fee schedule,Payment capped at billed charges,21.03,,,,,,,fee schedule,Payment capped at billed charges,14.1,,,,,,,fee schedule,Payment capped at billed charges,18.92,,,,,,,fee schedule,Payment capped at billed charges,35.26429448,,,,,,,fee schedule,Payment capped at billed charges,14.52,,,,,,,fee schedule,Payment capped at billed charges,15.59,,,,,,,fee schedule,,29.25,,,,,,,percent of total billed charges,
PT ULTRASOUND 15MIN,96000195,CDM,0420,RC,97035,CPT,11,Local,GP  ,outpatient,professional,,,37,150,10.1,90,cash pricing is a case rate for all services provided during a visit,14.67,,,,,,,fee schedule,,14.72,,,,,,,fee schedule,,35.65,,,,,,,fee schedule,Payment capped at billed charges,10.1,,,,,,,fee schedule,,31.73,,,,,,,fee schedule,Payment capped at billed charges,26.38,,,,,,,fee schedule,Payment capped at billed charges,14.24,,,,,,,fee schedule,payment capped at 80% of billed charges,31.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.41,,,,,,,fee schedule,Payment capped at billed charges,16.17,,,,,,,fee schedule,Payment capped at billed charges,11.39,,,,,,,fee schedule,Payment capped at billed charges,14.67,,,,,,,fee schedule,Payment capped at billed charges,16.43,,,,,,,fee schedule,Payment capped at billed charges,13.15,,,,,,,fee schedule,,33.56,,,,,,,fee schedule,Payment capped at billed charges,14.87,,,,,,,fee schedule,Payment capped at billed charges,21.41,,,,,,,fee schedule,Payment capped at billed charges,14.44,,,,,,,fee schedule,Payment capped at billed charges,19.26,,,,,,,fee schedule,Payment capped at billed charges,35.26429448,,,,,,,fee schedule,Payment capped at billed charges,14.87,,,,,,,fee schedule,Payment capped at billed charges,10.89,,,,,,,fee schedule,,24.05,,,,,,,percent of total billed charges,
PT THER EX EA 15 MIN,96000203,CDM,0420,RC,97110,CPT,11,Local,GP  ,outpatient,professional,,,80,150,27.16,90,cash pricing is a case rate for all services provided during a visit,30.26,,,,,,,fee schedule,,30.37,,,,,,,fee schedule,,72.98,,,,,,,fee schedule,Payment capped at billed charges,29.61,,,,,,,fee schedule,,64.95,,,,,,,fee schedule,Payment capped at billed charges,54.01,,,,,,,fee schedule,Payment capped at billed charges,29.36,,,,,,,fee schedule,payment capped at 80% of billed charges,68,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,40.1,,,,,,,fee schedule,Payment capped at billed charges,33.41,,,,,,,fee schedule,Payment capped at billed charges,33.38,,,,,,,fee schedule,Payment capped at billed charges,30.26,,,,,,,fee schedule,Payment capped at billed charges,33.96,,,,,,,fee schedule,Payment capped at billed charges,27.16,,,,,,,fee schedule,,69.34,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,42.31,,,,,,,fee schedule,Payment capped at billed charges,29.78,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,71.88918715,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,31.93,,,,,,,fee schedule,,52,,,,,,,percent of total billed charges,
PT NEURO RE-ED BAL 15MIN,96000211,CDM,0420,RC,97112,CPT,11,Local,GP  ,outpatient,professional,,,90,150,27.11,90,cash pricing is a case rate for all services provided during a visit,33.66,,,,,,,fee schedule,,33.78,,,,,,,fee schedule,,83.92,,,,,,,fee schedule,Payment capped at billed charges,27.11,,,,,,,fee schedule,,74.69,,,,,,,fee schedule,Payment capped at billed charges,62.1,,,,,,,fee schedule,Payment capped at billed charges,32.64,,,,,,,fee schedule,payment capped at 80% of billed charges,76.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.62,,,,,,,fee schedule,Payment capped at billed charges,37.17,,,,,,,fee schedule,Payment capped at billed charges,30.57,,,,,,,fee schedule,Payment capped at billed charges,33.66,,,,,,,fee schedule,Payment capped at billed charges,37.78,,,,,,,fee schedule,Payment capped at billed charges,30.22,,,,,,,fee schedule,,80.77,,,,,,,fee schedule,Payment capped at billed charges,34.12,,,,,,,fee schedule,Payment capped at billed charges,40.29,,,,,,,fee schedule,Payment capped at billed charges,33.12,,,,,,,fee schedule,Payment capped at billed charges,34.24,,,,,,,fee schedule,Payment capped at billed charges,82.56381781,,,,,,,fee schedule,Payment capped at billed charges,34.12,,,,,,,fee schedule,Payment capped at billed charges,29.24,,,,,,,fee schedule,,58.5,,,,,,,percent of total billed charges,
PT AQUA THER W/EXERCISE 15 MIN,96000229,CDM,0420,RC,97113,CPT,11,Local,GP  ,outpatient,professional,,,108,150,34.66,92.04,cash pricing is a case rate for all services provided during a visit,38.58,,,,,,,fee schedule,,38.72,,,,,,,fee schedule,,92.04,,,,,,,fee schedule,Payment capped at billed charges,34.66,,,,,,,fee schedule,,81.92,,,,,,,fee schedule,Payment capped at billed charges,68.11,,,,,,,fee schedule,Payment capped at billed charges,37.42,,,,,,,fee schedule,payment capped at 80% of billed charges,91.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,51.42,,,,,,,fee schedule,Payment capped at billed charges,42.85,,,,,,,fee schedule,Payment capped at billed charges,39.08,,,,,,,fee schedule,Payment capped at billed charges,38.58,,,,,,,fee schedule,Payment capped at billed charges,43.54,,,,,,,fee schedule,Payment capped at billed charges,34.84,,,,,,,fee schedule,,87.92,,,,,,,fee schedule,Payment capped at billed charges,39.1,,,,,,,fee schedule,Payment capped at billed charges,53.03,,,,,,,fee schedule,Payment capped at billed charges,37.96,,,,,,,fee schedule,Payment capped at billed charges,47.72,,,,,,,fee schedule,Payment capped at billed charges,90.21979024,,,,,,,fee schedule,Payment capped at billed charges,39.1,,,,,,,fee schedule,Payment capped at billed charges,37.38,,,,,,,fee schedule,,70.2,,,,,,,percent of total billed charges,
PT GAIT TRAINING EA 15 MIN,96000237,CDM,0420,RC,97116,CPT,11,Local,GP  ,outpatient,professional,,,76,150,22.52,90,cash pricing is a case rate for all services provided during a visit,30.26,,,,,,,fee schedule,,30.37,,,,,,,fee schedule,,72.98,,,,,,,fee schedule,Payment capped at billed charges,22.52,,,,,,,fee schedule,,64.95,,,,,,,fee schedule,Payment capped at billed charges,54.01,,,,,,,fee schedule,Payment capped at billed charges,29.36,,,,,,,fee schedule,payment capped at 80% of billed charges,64.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,40.1,,,,,,,fee schedule,Payment capped at billed charges,33.41,,,,,,,fee schedule,Payment capped at billed charges,25.39,,,,,,,fee schedule,Payment capped at billed charges,30.26,,,,,,,fee schedule,Payment capped at billed charges,33.96,,,,,,,fee schedule,Payment capped at billed charges,27.16,,,,,,,fee schedule,,69.34,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,35.91,,,,,,,fee schedule,Payment capped at billed charges,29.78,,,,,,,fee schedule,Payment capped at billed charges,32.08,,,,,,,fee schedule,Payment capped at billed charges,71.88918715,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,24.29,,,,,,,fee schedule,,49.4,,,,,,,percent of total billed charges,
PT COGNITIVE FUNC INTRV 1ST15M,96000245,CDM,0420,RC,97129,CPT,11,Local,GP  ,outpatient,professional,,,72,150,20.71,90,cash pricing is a case rate for all services provided during a visit,22.5,,,,,,,fee schedule,,22.58,,,,,,,fee schedule,,53.99,,,,,,,fee schedule,Payment capped at billed charges,20.71,,,,,,,fee schedule,,48.05,,,,,,,fee schedule,Payment capped at billed charges,39.95,,,,,,,fee schedule,Payment capped at billed charges,21.82,,,,,,,fee schedule,payment capped at 80% of billed charges,61.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.31,,,,,,,fee schedule,Payment capped at billed charges,24.42,,,,,,,fee schedule,Payment capped at billed charges,23.58,,,,,,,fee schedule,Payment capped at billed charges,22.5,,,,,,,fee schedule,Payment capped at billed charges,24.82,,,,,,,fee schedule,Payment capped at billed charges,36,,,,,,,fee schedule,,51.47,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,41.21,,,,,,,fee schedule,Payment capped at billed charges,22.14,,,,,,,fee schedule,Payment capped at billed charges,37.09,,,,,,,fee schedule,Payment capped at billed charges,54.00902627,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,22.55,,,,,,,fee schedule,,46.8,,,,,,,percent of total billed charges,
PT UNLISTED PM R,96000252,CDM,0420,RC,97139,CPT,11,Local,GP  ,outpatient,professional,,,65,150,13.08,90,cash pricing is a case rate for all services provided during a visit,65,,,,,,,fee schedule,,22.75,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,13.51,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,52,,,,,,,fee schedule,payment capped at 80% of billed charges,55.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,15.39,,,,,,,fee schedule,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,32.5,,,,,,,fee schedule,,42.85,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,31.6536,,,,,,,fee schedule,Payment capped at billed charges,13.2,,,,,,,fee schedule,Payment capped at billed charges,14.72,,,,,,,fee schedule,,42.25,,,,,,,percent of total billed charges,
PT MANUAL THER EA 15 MIN,96000260,CDM,0420,RC,97140,CPT,11,Local,GP  ,outpatient,professional,,,74,150,23.92,90,cash pricing is a case rate for all services provided during a visit,28.56,,,,,,,fee schedule,,28.67,,,,,,,fee schedule,,67.01,,,,,,,fee schedule,Payment capped at billed charges,23.92,,,,,,,fee schedule,,59.64,,,,,,,fee schedule,Payment capped at billed charges,49.59,,,,,,,fee schedule,Payment capped at billed charges,27.7,,,,,,,fee schedule,payment capped at 80% of billed charges,62.9,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,37.82,,,,,,,fee schedule,Payment capped at billed charges,31.51,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,28.56,,,,,,,fee schedule,Payment capped at billed charges,32.02,,,,,,,fee schedule,Payment capped at billed charges,25.62,,,,,,,fee schedule,,63.56,,,,,,,fee schedule,Payment capped at billed charges,28.95,,,,,,,fee schedule,Payment capped at billed charges,39.31,,,,,,,fee schedule,Payment capped at billed charges,28.1,,,,,,,fee schedule,Payment capped at billed charges,35.38,,,,,,,fee schedule,Payment capped at billed charges,66.10761063,,,,,,,fee schedule,Payment capped at billed charges,28.95,,,,,,,fee schedule,Payment capped at billed charges,25.8,,,,,,,fee schedule,,48.1,,,,,,,percent of total billed charges,
PT THERAPEUTIC PROCEDURES GRP,96000278,CDM,0423,RC,97150,CPT,11,Local,GP  ,outpatient,professional,,,46,150,16.42,90,cash pricing is a case rate for all services provided during a visit,18.36,,,,,,,fee schedule,,18.43,,,,,,,fee schedule,,44.65,,,,,,,fee schedule,Payment capped at billed charges,18.62,,,,,,,fee schedule,,39.74,,,,,,,fee schedule,Payment capped at billed charges,33.04,,,,,,,fee schedule,Payment capped at billed charges,17.81,,,,,,,fee schedule,payment capped at 80% of billed charges,39.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,24.24,,,,,,,fee schedule,Payment capped at billed charges,20.2,,,,,,,fee schedule,Payment capped at billed charges,20.99,,,,,,,fee schedule,Payment capped at billed charges,18.36,,,,,,,fee schedule,Payment capped at billed charges,20.53,,,,,,,fee schedule,Payment capped at billed charges,16.42,,,,,,,fee schedule,,41.18,,,,,,,fee schedule,Payment capped at billed charges,18.61,,,,,,,fee schedule,Payment capped at billed charges,23.94,,,,,,,fee schedule,Payment capped at billed charges,18.07,,,,,,,fee schedule,Payment capped at billed charges,21.54,,,,,,,fee schedule,Payment capped at billed charges,43.27335799,,,,,,,fee schedule,Payment capped at billed charges,18.61,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,,29.9,,,,,,,percent of total billed charges,
PT EVAL LOW COMPLEX,96000286,CDM,0424,RC,97161,CPT,11,Local,GP  ,outpatient,professional,,,262,150,70.58,249.59,cash pricing is a case rate for all services provided during a visit,103.06,,,,,,,fee schedule,,103.44,,,,,,,fee schedule,,249.59,,,,,,,fee schedule,Payment capped at billed charges,70.58,,,,,,,fee schedule,,222.14,,,,,,,fee schedule,Payment capped at billed charges,184.7,,,,,,,fee schedule,Payment capped at billed charges,99.97,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,136.49,,,,,,,fee schedule,Payment capped at billed charges,113.72,,,,,,,fee schedule,Payment capped at billed charges,79.58,,,,,,,fee schedule,Payment capped at billed charges,103.06,,,,,,,fee schedule,Payment capped at billed charges,115.57,,,,,,,fee schedule,Payment capped at billed charges,92.46,,,,,,,fee schedule,,235.81,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,145.69,,,,,,,fee schedule,Payment capped at billed charges,101.41,,,,,,,fee schedule,Payment capped at billed charges,131.12,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,76.12,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
PT EVAL MOD COMPLEX,96000294,CDM,0424,RC,97162,CPT,11,Local,GP  ,outpatient,professional,,,262,150,70.58,249.59,cash pricing is a case rate for all services provided during a visit,103.06,,,,,,,fee schedule,,103.44,,,,,,,fee schedule,,249.59,,,,,,,fee schedule,Payment capped at billed charges,70.58,,,,,,,fee schedule,,222.14,,,,,,,fee schedule,Payment capped at billed charges,184.7,,,,,,,fee schedule,Payment capped at billed charges,99.97,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,136.49,,,,,,,fee schedule,Payment capped at billed charges,113.72,,,,,,,fee schedule,Payment capped at billed charges,79.58,,,,,,,fee schedule,Payment capped at billed charges,103.06,,,,,,,fee schedule,Payment capped at billed charges,115.57,,,,,,,fee schedule,Payment capped at billed charges,92.46,,,,,,,fee schedule,,235.81,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,149.89,,,,,,,fee schedule,Payment capped at billed charges,101.41,,,,,,,fee schedule,Payment capped at billed charges,134.89,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,76.12,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
PT EVAL HIGH COMPLEX,96000302,CDM,0424,RC,97163,CPT,11,Local,GP  ,outpatient,professional,,,262,150,70.58,249.59,cash pricing is a case rate for all services provided during a visit,103.06,,,,,,,fee schedule,,103.44,,,,,,,fee schedule,,249.59,,,,,,,fee schedule,Payment capped at billed charges,70.58,,,,,,,fee schedule,,222.14,,,,,,,fee schedule,Payment capped at billed charges,184.7,,,,,,,fee schedule,Payment capped at billed charges,99.97,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,136.49,,,,,,,fee schedule,Payment capped at billed charges,113.72,,,,,,,fee schedule,Payment capped at billed charges,79.58,,,,,,,fee schedule,Payment capped at billed charges,103.06,,,,,,,fee schedule,Payment capped at billed charges,115.57,,,,,,,fee schedule,Payment capped at billed charges,92.46,,,,,,,fee schedule,,235.81,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,158.7,,,,,,,fee schedule,Payment capped at billed charges,101.41,,,,,,,fee schedule,Payment capped at billed charges,142.82,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,104.45,,,,,,,fee schedule,Payment capped at billed charges,76.12,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
PT RE-EVAL EST PLAN CARE,96000310,CDM,0424,RC,97164,CPT,11,Local,GP  ,outpatient,professional,,,183,150,48.13,174.39,cash pricing is a case rate for all services provided during a visit,71.23,,,,,,,fee schedule,,71.49,,,,,,,fee schedule,,174.39,,,,,,,fee schedule,Payment capped at billed charges,48.13,,,,,,,fee schedule,,155.21,,,,,,,fee schedule,Payment capped at billed charges,129.05,,,,,,,fee schedule,Payment capped at billed charges,69.08,,,,,,,fee schedule,payment capped at 80% of billed charges,155.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,94.71,,,,,,,fee schedule,Payment capped at billed charges,78.92,,,,,,,fee schedule,Payment capped at billed charges,54.27,,,,,,,fee schedule,Payment capped at billed charges,71.23,,,,,,,fee schedule,Payment capped at billed charges,80.2,,,,,,,fee schedule,Payment capped at billed charges,64.16,,,,,,,fee schedule,,163.77,,,,,,,fee schedule,Payment capped at billed charges,72.19,,,,,,,fee schedule,Payment capped at billed charges,101.19,,,,,,,fee schedule,Payment capped at billed charges,70.09,,,,,,,fee schedule,Payment capped at billed charges,91.06,,,,,,,fee schedule,Payment capped at billed charges,170.7075562,,,,,,,fee schedule,Payment capped at billed charges,72.19,,,,,,,fee schedule,Payment capped at billed charges,51.91,,,,,,,fee schedule,,118.95,,,,,,,percent of total billed charges,
PT THER ACT EA 15 MIN,96000328,CDM,0420,RC,97530,CPT,11,Local,GP  ,outpatient,professional,,,102,150,31.17,92.44,cash pricing is a case rate for all services provided during a visit,36.56,,,,,,,fee schedule,,36.69,,,,,,,fee schedule,,92.44,,,,,,,fee schedule,Payment capped at billed charges,31.17,,,,,,,fee schedule,,82.27,,,,,,,fee schedule,Payment capped at billed charges,68.41,,,,,,,fee schedule,Payment capped at billed charges,35.46,,,,,,,fee schedule,payment capped at 80% of billed charges,86.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,48.77,,,,,,,fee schedule,Payment capped at billed charges,40.64,,,,,,,fee schedule,Payment capped at billed charges,35.14,,,,,,,fee schedule,Payment capped at billed charges,36.56,,,,,,,fee schedule,Payment capped at billed charges,41.3,,,,,,,fee schedule,Payment capped at billed charges,33.03,,,,,,,fee schedule,,89.29,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,42.5,,,,,,,fee schedule,Payment capped at billed charges,35.98,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,91.25433935,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,33.62,,,,,,,fee schedule,,66.3,,,,,,,percent of total billed charges,
PT SENSORY INTEGRATON EA15 MIN,96000336,CDM,0420,RC,97533,CPT,11,Local,GP  ,outpatient,professional,,,172,150,23.32,159.83,cash pricing is a case rate for all services provided during a visit,64.38,,,,,,,fee schedule,,64.62,,,,,,,fee schedule,,159.83,,,,,,,fee schedule,Payment capped at billed charges,23.32,,,,,,,fee schedule,,142.25,,,,,,,fee schedule,Payment capped at billed charges,118.27,,,,,,,fee schedule,Payment capped at billed charges,62.45,,,,,,,fee schedule,payment capped at 80% of billed charges,146.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,86.8,,,,,,,fee schedule,Payment capped at billed charges,72.32,,,,,,,fee schedule,Payment capped at billed charges,26.29,,,,,,,fee schedule,Payment capped at billed charges,64.38,,,,,,,fee schedule,Payment capped at billed charges,73.5,,,,,,,fee schedule,Payment capped at billed charges,86,,,,,,,fee schedule,,158.57,,,,,,,fee schedule,Payment capped at billed charges,65.25,,,,,,,fee schedule,Payment capped at billed charges,55.21,,,,,,,fee schedule,Payment capped at billed charges,63.35,,,,,,,fee schedule,Payment capped at billed charges,49.69,,,,,,,fee schedule,Payment capped at billed charges,157.407535,,,,,,,fee schedule,Payment capped at billed charges,65.25,,,,,,,fee schedule,Payment capped at billed charges,25.15,,,,,,,fee schedule,,111.8,,,,,,,percent of total billed charges,
PT ADL SELF CARE/HOME IND 15M,96000344,CDM,0420,RC,97535,CPT,11,Local,GP  ,outpatient,professional,,,86,150,27.98,90,cash pricing is a case rate for all services provided during a visit,33.75,,,,,,,fee schedule,,33.87,,,,,,,fee schedule,,81.77,,,,,,,fee schedule,Payment capped at billed charges,27.98,,,,,,,fee schedule,,72.78,,,,,,,fee schedule,Payment capped at billed charges,60.51,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,payment capped at 80% of billed charges,73.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.89,,,,,,,fee schedule,Payment capped at billed charges,37.4,,,,,,,fee schedule,Payment capped at billed charges,31.54,,,,,,,fee schedule,Payment capped at billed charges,33.75,,,,,,,fee schedule,Payment capped at billed charges,38.01,,,,,,,fee schedule,Payment capped at billed charges,30.41,,,,,,,fee schedule,,77.97,,,,,,,fee schedule,Payment capped at billed charges,34.21,,,,,,,fee schedule,Payment capped at billed charges,39.26,,,,,,,fee schedule,Payment capped at billed charges,33.21,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,80.28765525,,,,,,,fee schedule,Payment capped at billed charges,34.21,,,,,,,fee schedule,Payment capped at billed charges,30.17,,,,,,,fee schedule,,55.9,,,,,,,percent of total billed charges,
PT COM/WORK REINTEG 15M,96000351,CDM,0420,RC,97537,CPT,11,Local,GP  ,outpatient,professional,,,84,150,24.2,90,cash pricing is a case rate for all services provided during a visit,33.35,,,,,,,fee schedule,,33.47,,,,,,,fee schedule,,78.84,,,,,,,fee schedule,Payment capped at billed charges,24.2,,,,,,,fee schedule,,70.17,,,,,,,fee schedule,Payment capped at billed charges,58.34,,,,,,,fee schedule,Payment capped at billed charges,67.2,,,,,,,fee schedule,payment capped at 80% of billed charges,71.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.24,,,,,,,fee schedule,Payment capped at billed charges,36.86,,,,,,,fee schedule,Payment capped at billed charges,27.29,,,,,,,fee schedule,Payment capped at billed charges,33.35,,,,,,,fee schedule,Payment capped at billed charges,37.46,,,,,,,fee schedule,Payment capped at billed charges,29.97,,,,,,,fee schedule,,74.98,,,,,,,fee schedule,Payment capped at billed charges,33.8,,,,,,,fee schedule,Payment capped at billed charges,39.26,,,,,,,fee schedule,Payment capped at billed charges,32.82,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,77.62208809,,,,,,,fee schedule,Payment capped at billed charges,33.8,,,,,,,fee schedule,Payment capped at billed charges,26.1,,,,,,,fee schedule,,54.6,,,,,,,percent of total billed charges,
PT WHEELCHAIR MGMT 15M,96000369,CDM,0420,RC,97542,CPT,11,Local,GP  ,outpatient,professional,,,83,150,27.74,90,cash pricing is a case rate for all services provided during a visit,32.3,,,,,,,fee schedule,,32.42,,,,,,,fee schedule,,,,,,,,,,service not payable,27.74,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,31.33,,,,,,,fee schedule,payment capped at 80% of billed charges,70.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,42.82,,,,,,,fee schedule,Payment capped at billed charges,35.68,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,32.3,,,,,,,fee schedule,Payment capped at billed charges,36.26,,,,,,,fee schedule,Payment capped at billed charges,29,,,,,,,fee schedule,,74.98,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,Payment capped at billed charges,32.56,,,,,,,fee schedule,Payment capped at billed charges,31.78,,,,,,,fee schedule,Payment capped at billed charges,29.68,,,,,,,fee schedule,Payment capped at billed charges,77.62208809,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,Payment capped at billed charges,32.3,,,,,,,fee schedule,,53.95,,,,,,,percent of total billed charges,
PT WRK HARD CONDT 2 HRS,96000377,CDM,0420,RC,97545,CPT,11,Local,GP  ,outpatient,professional,,,413,150,10.61,413,cash pricing is a case rate for all services provided during a visit,248.29,,,,,,,fee schedule,,144.55,,,,,,,fee schedule,,413,,,,,,,fee schedule,Payment capped at billed charges,10.61,,,,,,,fee schedule,,376.98,,,,,,,fee schedule,Payment capped at billed charges,313.44,,,,,,,fee schedule,Payment capped at billed charges,330.4,,,,,,,fee schedule,payment capped at 80% of billed charges,351.05,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,12.08,,,,,,,fee schedule,Payment capped at billed charges,268.45,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,206.5,,,,,,,fee schedule,,412.96,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,362.8,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,326.53,,,,,,,fee schedule,Payment capped at billed charges,305.5008,,,,,,,fee schedule,Payment capped at billed charges,127.43,,,,,,,fee schedule,Payment capped at billed charges,11.55,,,,,,,fee schedule,,268.45,,,,,,,percent of total billed charges,
PT WORK HARD COND ADD HR,96000385,CDM,0420,RC,97546,CPT,11,Local,GP  ,outpatient,professional,,,184,150,50.29,181.41,cash pricing is a case rate for all services provided during a visit,73.41,,,,,,,fee schedule,,64.4,,,,,,,fee schedule,,168.91,,,,,,,fee schedule,Payment capped at billed charges,62.56,,,,,,,fee schedule,,150.33,,,,,,,fee schedule,Payment capped at billed charges,124.99,,,,,,,fee schedule,Payment capped at billed charges,147.2,,,,,,,fee schedule,payment capped at 80% of billed charges,156.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,119.6,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,92,,,,,,,fee schedule,,163.16,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,181.41,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,163.27,,,,,,,fee schedule,Payment capped at billed charges,121.7018,,,,,,,fee schedule,Payment capped at billed charges,50.76,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,119.6,,,,,,,percent of total billed charges,
PT SELECT DEBRIDE1ST20SQCMLESS,96000393,CDM,0420,RC,97597,CPT,11,Local,GP  ,outpatient,professional,,,273,150,60.42,258.99,cash pricing is a case rate for all services provided during a visit,103.19,,,,,,,fee schedule,,103.57,,,,,,,fee schedule,,258.99,,,,,,,fee schedule,Payment capped at billed charges,60.42,,,,,,,fee schedule,,230.5,,,,,,,fee schedule,Payment capped at billed charges,191.65,,,,,,,fee schedule,Payment capped at billed charges,100.09,,,,,,,fee schedule,payment capped at 80% of billed charges,232.05,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,138.73,,,,,,,fee schedule,Payment capped at billed charges,115.59,,,,,,,fee schedule,Payment capped at billed charges,68.79,,,,,,,fee schedule,Payment capped at billed charges,103.19,,,,,,,fee schedule,Payment capped at billed charges,117.47,,,,,,,fee schedule,Payment capped at billed charges,93.98,,,,,,,fee schedule,,251.6,,,,,,,fee schedule,Payment capped at billed charges,104.59,,,,,,,fee schedule,Payment capped at billed charges,105.38,,,,,,,fee schedule,Payment capped at billed charges,101.54,,,,,,,fee schedule,Payment capped at billed charges,94.83,,,,,,,fee schedule,Payment capped at billed charges,250.0842828,,,,,,,fee schedule,Payment capped at billed charges,104.59,,,,,,,fee schedule,Payment capped at billed charges,65.8,,,,,,,fee schedule,,177.45,,,,,,,percent of total billed charges,
PT SELECT DEBRIDE EA ADD20SQCM,96000401,CDM,0420,RC,97598,CPT,11,Local,GP  ,outpatient,professional,,,138,150,25.94,133.51,cash pricing is a case rate for all services provided during a visit,46.16,,,,,,,fee schedule,,46.33,,,,,,,fee schedule,,113.77,,,,,,,fee schedule,Payment capped at billed charges,25.94,,,,,,,fee schedule,,101.26,,,,,,,fee schedule,Payment capped at billed charges,84.19,,,,,,,fee schedule,Payment capped at billed charges,44.78,,,,,,,fee schedule,payment capped at 80% of billed charges,117.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,61.31,,,,,,,fee schedule,Payment capped at billed charges,51.08,,,,,,,fee schedule,Payment capped at billed charges,29.53,,,,,,,fee schedule,Payment capped at billed charges,46.16,,,,,,,fee schedule,Payment capped at billed charges,51.91,,,,,,,fee schedule,Payment capped at billed charges,41.53,,,,,,,fee schedule,,110.28,,,,,,,fee schedule,Payment capped at billed charges,46.78,,,,,,,fee schedule,Payment capped at billed charges,133.51,,,,,,,fee schedule,Payment capped at billed charges,45.42,,,,,,,fee schedule,Payment capped at billed charges,120.17,,,,,,,fee schedule,Payment capped at billed charges,111.1441061,,,,,,,fee schedule,Payment capped at billed charges,46.78,,,,,,,fee schedule,Payment capped at billed charges,28.25,,,,,,,fee schedule,,89.7,,,,,,,percent of total billed charges,
PT PHYSICAL PERF TEST EA 15MIN,96000419,CDM,0420,RC,97750,CPT,11,Local,GP  ,outpatient,professional,,,90,150,26.23,90,cash pricing is a case rate for all services provided during a visit,35.15,,,,,,,fee schedule,,35.28,,,,,,,fee schedule,,85.3,,,,,,,fee schedule,Payment capped at billed charges,26.23,,,,,,,fee schedule,,75.92,,,,,,,fee schedule,Payment capped at billed charges,63.12,,,,,,,fee schedule,Payment capped at billed charges,34.1,,,,,,,fee schedule,payment capped at 80% of billed charges,76.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,46.8,,,,,,,fee schedule,Payment capped at billed charges,38.99,,,,,,,fee schedule,Payment capped at billed charges,29.58,,,,,,,fee schedule,Payment capped at billed charges,35.15,,,,,,,fee schedule,Payment capped at billed charges,39.63,,,,,,,fee schedule,Payment capped at billed charges,31.7,,,,,,,fee schedule,,79.68,,,,,,,fee schedule,Payment capped at billed charges,35.63,,,,,,,fee schedule,Payment capped at billed charges,60.32,,,,,,,fee schedule,Payment capped at billed charges,34.59,,,,,,,fee schedule,Payment capped at billed charges,54.58,,,,,,,fee schedule,Payment capped at billed charges,82.80719568,,,,,,,fee schedule,Payment capped at billed charges,35.63,,,,,,,fee schedule,Payment capped at billed charges,28.29,,,,,,,fee schedule,,58.5,,,,,,,percent of total billed charges,
PT ASSISTIVE TECHN ASSES 15MIN,96000427,CDM,0420,RC,97755,CPT,11,Local,GP  ,outpatient,professional,,,100,150,28.23,95.04,cash pricing is a case rate for all services provided during a visit,39.43,,,,,,,fee schedule,,39.58,,,,,,,fee schedule,,95.04,,,,,,,fee schedule,Payment capped at billed charges,28.23,,,,,,,fee schedule,,84.59,,,,,,,fee schedule,Payment capped at billed charges,70.33,,,,,,,fee schedule,Payment capped at billed charges,38.25,,,,,,,fee schedule,payment capped at 80% of billed charges,85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,52.08,,,,,,,fee schedule,Payment capped at billed charges,43.39,,,,,,,fee schedule,Payment capped at billed charges,31.83,,,,,,,fee schedule,Payment capped at billed charges,39.43,,,,,,,fee schedule,Payment capped at billed charges,44.1,,,,,,,fee schedule,Payment capped at billed charges,35.28,,,,,,,fee schedule,,88.72,,,,,,,fee schedule,Payment capped at billed charges,39.96,,,,,,,fee schedule,Payment capped at billed charges,72.04,,,,,,,fee schedule,Payment capped at billed charges,38.8,,,,,,,fee schedule,Payment capped at billed charges,64.84,,,,,,,fee schedule,Payment capped at billed charges,93.91063496,,,,,,,fee schedule,Payment capped at billed charges,39.96,,,,,,,fee schedule,Payment capped at billed charges,30.45,,,,,,,fee schedule,,65,,,,,,,percent of total billed charges,
PT ORTH FIT/TRAIN INIT EA15MIN,96000435,CDM,0420,RC,97760,CPT,11,Local,GP  ,outpatient,professional,,,130,150,42.87,119.5170774,cash pricing is a case rate for all services provided during a visit,48.65,,,,,,,fee schedule,,48.83,,,,,,,fee schedule,,,,,,,,,,service not payable,42.87,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,47.19,,,,,,,fee schedule,payment capped at 80% of billed charges,110.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,65.17,,,,,,,fee schedule,Payment capped at billed charges,54.3,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,48.65,,,,,,,fee schedule,Payment capped at billed charges,55.19,,,,,,,fee schedule,Payment capped at billed charges,44.15,,,,,,,fee schedule,,117.81,,,,,,,fee schedule,Payment capped at billed charges,49.31,,,,,,,fee schedule,Payment capped at billed charges,53.68,,,,,,,fee schedule,Payment capped at billed charges,47.87,,,,,,,fee schedule,Payment capped at billed charges,48.3,,,,,,,fee schedule,Payment capped at billed charges,119.5170774,,,,,,,fee schedule,Payment capped at billed charges,49.31,,,,,,,fee schedule,Payment capped at billed charges,48.65,,,,,,,fee schedule,,84.5,,,,,,,percent of total billed charges,
PT PROSTH TRAIN INIT EA 15MIN,96000443,CDM,0420,RC,97761,CPT,11,Local,GP  ,outpatient,professional,,,111,150,36.5,102.7201412,cash pricing is a case rate for all services provided during a visit,42.72,,,,,,,fee schedule,,42.88,,,,,,,fee schedule,,,,,,,,,,service not payable,36.5,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,41.44,,,,,,,fee schedule,payment capped at 80% of billed charges,94.35,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,57.05,,,,,,,fee schedule,Payment capped at billed charges,47.54,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,42.72,,,,,,,fee schedule,Payment capped at billed charges,48.31,,,,,,,fee schedule,Payment capped at billed charges,38.65,,,,,,,fee schedule,,99.72,,,,,,,fee schedule,Payment capped at billed charges,43.3,,,,,,,fee schedule,Payment capped at billed charges,53.33,,,,,,,fee schedule,Payment capped at billed charges,42.04,,,,,,,fee schedule,Payment capped at billed charges,48.01,,,,,,,fee schedule,Payment capped at billed charges,102.7201412,,,,,,,fee schedule,Payment capped at billed charges,43.3,,,,,,,fee schedule,Payment capped at billed charges,42.72,,,,,,,fee schedule,,72.15,,,,,,,percent of total billed charges,
PT ORTH/PROS SUBS ENC EA15MIN,96000450,CDM,0420,RC,97763,CPT,11,Local,GP  ,outpatient,professional,,,144,150,47.77,131.86,cash pricing is a case rate for all services provided during a visit,53.22,,,,,,,fee schedule,,53.42,,,,,,,fee schedule,,,,,,,,,,service not payable,47.77,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,51.63,,,,,,,fee schedule,payment capped at 80% of billed charges,122.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,71.5,,,,,,,fee schedule,Payment capped at billed charges,59.57,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,53.22,,,,,,,fee schedule,Payment capped at billed charges,60.54,,,,,,,fee schedule,Payment capped at billed charges,72,,,,,,,fee schedule,,131.86,,,,,,,fee schedule,Payment capped at billed charges,53.94,,,,,,,fee schedule,Payment capped at billed charges,75.2,,,,,,,fee schedule,Payment capped at billed charges,52.37,,,,,,,fee schedule,Payment capped at billed charges,67.68,,,,,,,fee schedule,Payment capped at billed charges,131.3722839,,,,,,,fee schedule,Payment capped at billed charges,53.94,,,,,,,fee schedule,Payment capped at billed charges,53.22,,,,,,,fee schedule,,93.6,,,,,,,percent of total billed charges,
PT DRIVING EVAL,96000468,CDM,0420,RC,97799,CPT,11,Local,GP  ,outpatient,professional,,,350,150,20.2,350,cash pricing is a case rate for all services provided during a visit,350,,,,,,,fee schedule,,122.5,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,20.2,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,227.5,,,,,,,fee schedule,Payment capped at billed charges,280,,,,,,,fee schedule,payment capped at 80% of billed charges,297.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,23,,,,,,,fee schedule,Payment capped at billed charges,227.5,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,175,,,,,,,fee schedule,,227.5,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,service not payable,,,,,,,,,service not payable,22,,,,,,,fee schedule,,227.5,,,,,,,percent of total billed charges,
OT BIOFEEDBACK TRAIN ANY METH,96000476,CDM,0430,RC,90901,CPT,11,Local,GO  ,outpatient,professional,,,141,150,28.82,120.85,cash pricing is a case rate for all services provided during a visit,41.92,,,,,,,fee schedule,,42.07,,,,,,,fee schedule,,120.85,,,,,,,fee schedule,Payment capped at billed charges,28.82,,,,,,,fee schedule,,107.56,,,,,,,fee schedule,Payment capped at billed charges,89.43,,,,,,,fee schedule,Payment capped at billed charges,40.66,,,,,,,fee schedule,payment capped at 80% of billed charges,119.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,56.09,,,,,,,fee schedule,Payment capped at billed charges,46.73,,,,,,,fee schedule,Payment capped at billed charges,32.81,,,,,,,fee schedule,Payment capped at billed charges,54.5,,,,,,,fee schedule,Payment capped at billed charges,47.49,,,,,,,fee schedule,Payment capped at billed charges,70.5,,,,,,,fee schedule,,120.5,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,80.01,,,,,,,fee schedule,Payment capped at billed charges,41.25,,,,,,,fee schedule,Payment capped at billed charges,72,,,,,,,fee schedule,Payment capped at billed charges,100.638681,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,31.38,,,,,,,fee schedule,,91.65,,,,,,,percent of total billed charges,
OT DEVEL TEST ADMIN 1ST HR,96000484,CDM,0430,RC,96112,CPT,11,Local,GO  ,outpatient,professional,,,378,150,90,354.81,cash pricing is a case rate for all services provided during a visit,133.43,,,,,,,fee schedule,,133.92,,,,,,,fee schedule,,350.03,,,,,,,fee schedule,Payment capped at billed charges,116.84,,,,,,,fee schedule,,311.53,,,,,,,fee schedule,Payment capped at billed charges,259.02,,,,,,,fee schedule,Payment capped at billed charges,129.43,,,,,,,fee schedule,payment capped at 80% of billed charges,321.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,173.89,,,,,,,fee schedule,Payment capped at billed charges,144.89,,,,,,,fee schedule,Payment capped at billed charges,133.03,,,,,,,fee schedule,Payment capped at billed charges,173.46,,,,,,,fee schedule,Payment capped at billed charges,147.24,,,,,,,fee schedule,Payment capped at billed charges,117.79,,,,,,,fee schedule,,354.81,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,261.71,,,,,,,fee schedule,Payment capped at billed charges,131.3,,,,,,,fee schedule,Payment capped at billed charges,235.55,,,,,,,fee schedule,Payment capped at billed charges,304.0647219,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,127.25,,,,,,,fee schedule,,245.7,,,,,,,percent of total billed charges,
OT DEVEL TEST ADMIN EA ADD 30M,96000492,CDM,0430,RC,96113,CPT,11,Local,GO  ,outpatient,professional,,,169,150,49.16,169,cash pricing is a case rate for all services provided during a visit,55.66,,,,,,,fee schedule,,55.86,,,,,,,fee schedule,,169,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,151.55,,,,,,,fee schedule,Payment capped at billed charges,126.01,,,,,,,fee schedule,Payment capped at billed charges,53.99,,,,,,,fee schedule,payment capped at 80% of billed charges,143.65,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,72.56,,,,,,,fee schedule,Payment capped at billed charges,60.46,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,72.36,,,,,,,fee schedule,Payment capped at billed charges,61.45,,,,,,,fee schedule,Payment capped at billed charges,49.16,,,,,,,fee schedule,,168.24,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,123.18,,,,,,,fee schedule,Payment capped at billed charges,54.77,,,,,,,fee schedule,Payment capped at billed charges,110.86,,,,,,,fee schedule,Payment capped at billed charges,144.044931,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,109.85,,,,,,,percent of total billed charges,
OT COG PERF TEST PER HR,96000500,CDM,0434,RC,96125,CPT,11,Local,GO  ,outpatient,professional,,,305,150,90,297.27,cash pricing is a case rate for all services provided during a visit,104.58,,,,,,,fee schedule,,104.96,,,,,,,fee schedule,,293.78,,,,,,,fee schedule,Payment capped at billed charges,90.19,,,,,,,fee schedule,,261.46,,,,,,,fee schedule,Payment capped at billed charges,217.4,,,,,,,fee schedule,Payment capped at billed charges,101.45,,,,,,,fee schedule,payment capped at 80% of billed charges,259.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,138,,,,,,,fee schedule,Payment capped at billed charges,114.98,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,135.95,,,,,,,fee schedule,Payment capped at billed charges,116.85,,,,,,,fee schedule,Payment capped at billed charges,152.5,,,,,,,fee schedule,,297.27,,,,,,,fee schedule,Payment capped at billed charges,105.99,,,,,,,fee schedule,Payment capped at billed charges,251.15,,,,,,,fee schedule,Payment capped at billed charges,102.91,,,,,,,fee schedule,Payment capped at billed charges,226.03,,,,,,,fee schedule,Payment capped at billed charges,248.9168417,,,,,,,fee schedule,Payment capped at billed charges,105.99,,,,,,,fee schedule,Payment capped at billed charges,104.58,,,,,,,fee schedule,,198.25,,,,,,,percent of total billed charges,
OT MECHANICAL TRACTION THERAPY,96000518,CDM,0430,RC,97012,CPT,11,Local,GO  ,outpatient,professional,,,41,150,12.92,90,cash pricing is a case rate for all services provided during a visit,14.95,,,,,,,fee schedule,,15.01,,,,,,,fee schedule,,35.24,,,,,,,fee schedule,Payment capped at billed charges,12.92,,,,,,,fee schedule,,31.36,,,,,,,fee schedule,Payment capped at billed charges,26.08,,,,,,,fee schedule,Payment capped at billed charges,14.5,,,,,,,fee schedule,payment capped at 80% of billed charges,34.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.68,,,,,,,fee schedule,Payment capped at billed charges,16.4,,,,,,,fee schedule,Payment capped at billed charges,14.57,,,,,,,fee schedule,Payment capped at billed charges,19.43,,,,,,,fee schedule,Payment capped at billed charges,16.66,,,,,,,fee schedule,Payment capped at billed charges,13.34,,,,,,,fee schedule,,33.06,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,24.03,,,,,,,fee schedule,Payment capped at billed charges,14.71,,,,,,,fee schedule,Payment capped at billed charges,21.64,,,,,,,fee schedule,Payment capped at billed charges,35.06959218,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,13.94,,,,,,,fee schedule,,26.65,,,,,,,percent of total billed charges,
OT E-STIM UNATT,96000526,CDM,0430,RC,97014,CPT,11,Local,GO  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,16.89,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
OT E-STIM WOUND CARE UNATTEND,96000534,CDM,0430,RC,97014,CPT,11,Local,GO  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,16.89,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
OT E-STIM NOT WND PART TX PLAN,96000542,CDM,0430,RC,97014,CPT,11,Local,GO  ,outpatient,professional,,,57,150,9.19,90,cash pricing is a case rate for all services provided during a visit,17.02,,,,,,,fee schedule,,19.95,,,,,,,fee schedule,,31.45,,,,,,,fee schedule,Payment capped at billed charges,12.65,,,,,,,fee schedule,,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.27,,,,,,,fee schedule,Payment capped at billed charges,12.6,,,,,,,fee schedule,payment capped at 80% of billed charges,48.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,14.4,,,,,,,fee schedule,Payment capped at billed charges,16.89,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,11.64,,,,,,,fee schedule,,29.63,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.29,,,,,,,fee schedule,Payment capped at billed charges,30.37124034,,,,,,,fee schedule,Payment capped at billed charges,9.28,,,,,,,fee schedule,Payment capped at billed charges,13.77,,,,,,,fee schedule,,37.05,,,,,,,percent of total billed charges,
OT VASOPNEUMATIC DEVICES,96000559,CDM,0430,RC,97016,CPT,11,Local,GO  ,outpatient,professional,,,49,150,10.99,90,cash pricing is a case rate for all services provided during a visit,12.29,,,,,,,fee schedule,,12.34,,,,,,,fee schedule,,29.66,,,,,,,fee schedule,Payment capped at billed charges,13.19,,,,,,,fee schedule,,26.4,,,,,,,fee schedule,Payment capped at billed charges,21.95,,,,,,,fee schedule,Payment capped at billed charges,11.92,,,,,,,fee schedule,payment capped at 80% of billed charges,41.65,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,16.23,,,,,,,fee schedule,Payment capped at billed charges,13.52,,,,,,,fee schedule,Payment capped at billed charges,14.13,,,,,,,fee schedule,Payment capped at billed charges,15.98,,,,,,,fee schedule,Payment capped at billed charges,13.74,,,,,,,fee schedule,Payment capped at billed charges,10.99,,,,,,,fee schedule,,27.92,,,,,,,fee schedule,Payment capped at billed charges,12.46,,,,,,,fee schedule,Payment capped at billed charges,34.95,,,,,,,fee schedule,Payment capped at billed charges,12.09,,,,,,,fee schedule,Payment capped at billed charges,31.6,,,,,,,fee schedule,Payment capped at billed charges,28.69154672,,,,,,,fee schedule,Payment capped at billed charges,12.46,,,,,,,fee schedule,Payment capped at billed charges,13.52,,,,,,,fee schedule,,31.85,,,,,,,percent of total billed charges,
OT PARAFFIN BATH,96000567,CDM,0430,RC,97018,CPT,11,Local,GO  ,outpatient,professional,,,50,150,5.93,90,cash pricing is a case rate for all services provided during a visit,6.59,,,,,,,fee schedule,,6.61,,,,,,,fee schedule,,,,,,,,,,service not payable,6.51,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,6.39,,,,,,,fee schedule,payment capped at 80% of billed charges,42.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,8.75,,,,,,,fee schedule,Payment capped at billed charges,7.29,,,,,,,fee schedule,Payment capped at billed charges,6.97,,,,,,,fee schedule,Payment capped at billed charges,8.57,,,,,,,fee schedule,Payment capped at billed charges,7.41,,,,,,,fee schedule,Payment capped at billed charges,5.93,,,,,,,fee schedule,,13.92,,,,,,,fee schedule,Payment capped at billed charges,6.68,,,,,,,fee schedule,Payment capped at billed charges,31.12,,,,,,,fee schedule,Payment capped at billed charges,6.48,,,,,,,fee schedule,Payment capped at billed charges,27.77,,,,,,,fee schedule,Payment capped at billed charges,14.15841103,,,,,,,fee schedule,Payment capped at billed charges,6.68,,,,,,,fee schedule,Payment capped at billed charges,6.67,,,,,,,fee schedule,,32.5,,,,,,,percent of total billed charges,
OT MODALTY WHIRLPOOL,96000575,CDM,0430,RC,97022,CPT,11,Local,GO  ,outpatient,professional,,,62,150,14.92,90,cash pricing is a case rate for all services provided during a visit,16.49,,,,,,,fee schedule,,16.55,,,,,,,fee schedule,,44.16,,,,,,,fee schedule,Payment capped at billed charges,19.19,,,,,,,fee schedule,,39.3,,,,,,,fee schedule,Payment capped at billed charges,32.68,,,,,,,fee schedule,Payment capped at billed charges,16,,,,,,,fee schedule,payment capped at 80% of billed charges,52.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,22.02,,,,,,,fee schedule,Payment capped at billed charges,18.35,,,,,,,fee schedule,Payment capped at billed charges,20.76,,,,,,,fee schedule,Payment capped at billed charges,21.44,,,,,,,fee schedule,Payment capped at billed charges,18.65,,,,,,,fee schedule,Payment capped at billed charges,14.92,,,,,,,fee schedule,,41.82,,,,,,,fee schedule,Payment capped at billed charges,16.71,,,,,,,fee schedule,Payment capped at billed charges,32.56,,,,,,,fee schedule,Payment capped at billed charges,16.23,,,,,,,fee schedule,Payment capped at billed charges,29.68,,,,,,,fee schedule,Payment capped at billed charges,42.17777125,,,,,,,fee schedule,Payment capped at billed charges,16.71,,,,,,,fee schedule,Payment capped at billed charges,19.86,,,,,,,fee schedule,,40.3,,,,,,,percent of total billed charges,
OT E-STIM ATTENDED PER 15 MIN,96000583,CDM,0430,RC,97032,CPT,11,Local,GO  ,outpatient,professional,,,48,150,13.34,90,cash pricing is a case rate for all services provided during a visit,14.95,,,,,,,fee schedule,,15.01,,,,,,,fee schedule,,36.15,,,,,,,fee schedule,Payment capped at billed charges,15.26,,,,,,,fee schedule,,32.17,,,,,,,fee schedule,Payment capped at billed charges,26.75,,,,,,,fee schedule,Payment capped at billed charges,14.5,,,,,,,fee schedule,payment capped at 80% of billed charges,40.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.68,,,,,,,fee schedule,Payment capped at billed charges,16.4,,,,,,,fee schedule,Payment capped at billed charges,17.2,,,,,,,fee schedule,Payment capped at billed charges,19.43,,,,,,,fee schedule,Payment capped at billed charges,16.66,,,,,,,fee schedule,Payment capped at billed charges,13.34,,,,,,,fee schedule,,33.93,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,21.77,,,,,,,fee schedule,Payment capped at billed charges,14.71,,,,,,,fee schedule,Payment capped at billed charges,19.61,,,,,,,fee schedule,Payment capped at billed charges,35.06959218,,,,,,,fee schedule,Payment capped at billed charges,15.15,,,,,,,fee schedule,Payment capped at billed charges,16.46,,,,,,,fee schedule,,31.2,,,,,,,percent of total billed charges,
OT IONTOPHERESIS 15 MIN,96000591,CDM,0430,RC,97033,CPT,11,Local,GO  ,outpatient,professional,,,59,150,17.83,90,cash pricing is a case rate for all services provided during a visit,19.81,,,,,,,fee schedule,,19.88,,,,,,,fee schedule,,49.56,,,,,,,fee schedule,Payment capped at billed charges,17.83,,,,,,,fee schedule,,44.11,,,,,,,fee schedule,Payment capped at billed charges,36.67,,,,,,,fee schedule,Payment capped at billed charges,19.22,,,,,,,fee schedule,payment capped at 80% of billed charges,50.15,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,26.31,,,,,,,fee schedule,Payment capped at billed charges,21.92,,,,,,,fee schedule,Payment capped at billed charges,20.1,,,,,,,fee schedule,Payment capped at billed charges,25.75,,,,,,,fee schedule,Payment capped at billed charges,22.28,,,,,,,fee schedule,Payment capped at billed charges,17.83,,,,,,,fee schedule,,46.72,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,Payment capped at billed charges,31.54,,,,,,,fee schedule,Payment capped at billed charges,19.49,,,,,,,fee schedule,Payment capped at billed charges,28.38,,,,,,,fee schedule,Payment capped at billed charges,48.45846557,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,Payment capped at billed charges,19.23,,,,,,,fee schedule,,38.35,,,,,,,percent of total billed charges,
OT CONTRAST BATH THERAPY,96000609,CDM,0430,RC,97034,CPT,11,Local,GO  ,outpatient,professional,,,45,150,12.83,90,cash pricing is a case rate for all services provided during a visit,14.33,,,,,,,fee schedule,,14.38,,,,,,,fee schedule,,35.65,,,,,,,fee schedule,Payment capped at billed charges,14.45,,,,,,,fee schedule,,31.73,,,,,,,fee schedule,Payment capped at billed charges,26.38,,,,,,,fee schedule,Payment capped at billed charges,13.9,,,,,,,fee schedule,payment capped at 80% of billed charges,38.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,18.93,,,,,,,fee schedule,Payment capped at billed charges,15.78,,,,,,,fee schedule,Payment capped at billed charges,16.3,,,,,,,fee schedule,Payment capped at billed charges,18.63,,,,,,,fee schedule,Payment capped at billed charges,16.03,,,,,,,fee schedule,Payment capped at billed charges,12.83,,,,,,,fee schedule,,34.43,,,,,,,fee schedule,Payment capped at billed charges,14.52,,,,,,,fee schedule,Payment capped at billed charges,21.03,,,,,,,fee schedule,Payment capped at billed charges,14.1,,,,,,,fee schedule,Payment capped at billed charges,18.92,,,,,,,fee schedule,Payment capped at billed charges,35.26429448,,,,,,,fee schedule,Payment capped at billed charges,14.52,,,,,,,fee schedule,Payment capped at billed charges,15.59,,,,,,,fee schedule,,29.25,,,,,,,percent of total billed charges,
OT ULTRASOUND 15MIN,96000617,CDM,0430,RC,97035,CPT,11,Local,GO  ,outpatient,professional,,,37,150,10.1,90,cash pricing is a case rate for all services provided during a visit,14.67,,,,,,,fee schedule,,14.72,,,,,,,fee schedule,,35.65,,,,,,,fee schedule,Payment capped at billed charges,10.1,,,,,,,fee schedule,,31.73,,,,,,,fee schedule,Payment capped at billed charges,26.38,,,,,,,fee schedule,Payment capped at billed charges,14.24,,,,,,,fee schedule,payment capped at 80% of billed charges,31.45,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,19.41,,,,,,,fee schedule,Payment capped at billed charges,16.17,,,,,,,fee schedule,Payment capped at billed charges,11.39,,,,,,,fee schedule,Payment capped at billed charges,19.07,,,,,,,fee schedule,Payment capped at billed charges,16.43,,,,,,,fee schedule,Payment capped at billed charges,13.15,,,,,,,fee schedule,,33.56,,,,,,,fee schedule,Payment capped at billed charges,14.87,,,,,,,fee schedule,Payment capped at billed charges,21.41,,,,,,,fee schedule,Payment capped at billed charges,14.44,,,,,,,fee schedule,Payment capped at billed charges,19.26,,,,,,,fee schedule,Payment capped at billed charges,35.26429448,,,,,,,fee schedule,Payment capped at billed charges,14.87,,,,,,,fee schedule,Payment capped at billed charges,10.89,,,,,,,fee schedule,,24.05,,,,,,,percent of total billed charges,
OT THER EX EA 15 MIN,96000625,CDM,0430,RC,97110,CPT,11,Local,GO  ,outpatient,professional,,,80,150,27.16,90,cash pricing is a case rate for all services provided during a visit,30.26,,,,,,,fee schedule,,30.37,,,,,,,fee schedule,,72.98,,,,,,,fee schedule,Payment capped at billed charges,29.61,,,,,,,fee schedule,,64.95,,,,,,,fee schedule,Payment capped at billed charges,54.01,,,,,,,fee schedule,Payment capped at billed charges,29.36,,,,,,,fee schedule,payment capped at 80% of billed charges,68,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,40.1,,,,,,,fee schedule,Payment capped at billed charges,33.41,,,,,,,fee schedule,Payment capped at billed charges,33.38,,,,,,,fee schedule,Payment capped at billed charges,39.34,,,,,,,fee schedule,Payment capped at billed charges,33.96,,,,,,,fee schedule,Payment capped at billed charges,27.16,,,,,,,fee schedule,,69.34,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,42.31,,,,,,,fee schedule,Payment capped at billed charges,29.78,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,71.88918715,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,31.93,,,,,,,fee schedule,,52,,,,,,,percent of total billed charges,
OT NEURO RE-ED BAL 15MIN,96000633,CDM,0430,RC,97112,CPT,11,Local,GO  ,outpatient,professional,,,90,150,27.11,90,cash pricing is a case rate for all services provided during a visit,33.66,,,,,,,fee schedule,,33.78,,,,,,,fee schedule,,83.92,,,,,,,fee schedule,Payment capped at billed charges,27.11,,,,,,,fee schedule,,74.69,,,,,,,fee schedule,Payment capped at billed charges,62.1,,,,,,,fee schedule,Payment capped at billed charges,32.64,,,,,,,fee schedule,payment capped at 80% of billed charges,76.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.62,,,,,,,fee schedule,Payment capped at billed charges,37.17,,,,,,,fee schedule,Payment capped at billed charges,30.57,,,,,,,fee schedule,Payment capped at billed charges,43.76,,,,,,,fee schedule,Payment capped at billed charges,37.78,,,,,,,fee schedule,Payment capped at billed charges,30.22,,,,,,,fee schedule,,80.77,,,,,,,fee schedule,Payment capped at billed charges,34.12,,,,,,,fee schedule,Payment capped at billed charges,40.29,,,,,,,fee schedule,Payment capped at billed charges,33.12,,,,,,,fee schedule,Payment capped at billed charges,34.24,,,,,,,fee schedule,Payment capped at billed charges,82.56381781,,,,,,,fee schedule,Payment capped at billed charges,34.12,,,,,,,fee schedule,Payment capped at billed charges,29.24,,,,,,,fee schedule,,58.5,,,,,,,percent of total billed charges,
OT COGNITIVE FUNC INTRV 1ST15M,96000641,CDM,0430,RC,97129,CPT,11,Local,GO  ,outpatient,professional,,,72,150,20.71,90,cash pricing is a case rate for all services provided during a visit,22.5,,,,,,,fee schedule,,22.58,,,,,,,fee schedule,,53.99,,,,,,,fee schedule,Payment capped at billed charges,20.71,,,,,,,fee schedule,,48.05,,,,,,,fee schedule,Payment capped at billed charges,39.95,,,,,,,fee schedule,Payment capped at billed charges,21.82,,,,,,,fee schedule,payment capped at 80% of billed charges,61.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.31,,,,,,,fee schedule,Payment capped at billed charges,24.42,,,,,,,fee schedule,Payment capped at billed charges,23.58,,,,,,,fee schedule,Payment capped at billed charges,29.25,,,,,,,fee schedule,Payment capped at billed charges,24.82,,,,,,,fee schedule,Payment capped at billed charges,36,,,,,,,fee schedule,,51.47,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,41.21,,,,,,,fee schedule,Payment capped at billed charges,22.14,,,,,,,fee schedule,Payment capped at billed charges,37.09,,,,,,,fee schedule,Payment capped at billed charges,54.00902627,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,22.55,,,,,,,fee schedule,,46.8,,,,,,,percent of total billed charges,
OT COGNITIVE FUNC INTRV ADD15M,96000658,CDM,0430,RC,97130,CPT,11,Local,GO  ,outpatient,professional,,,72,150,19.79,90,cash pricing is a case rate for all services provided during a visit,21.49,,,,,,,fee schedule,,21.57,,,,,,,fee schedule,,51.55,,,,,,,fee schedule,Payment capped at billed charges,19.79,,,,,,,fee schedule,,45.88,,,,,,,fee schedule,Payment capped at billed charges,38.15,,,,,,,fee schedule,Payment capped at billed charges,20.85,,,,,,,fee schedule,payment capped at 80% of billed charges,61.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.32,,,,,,,fee schedule,Payment capped at billed charges,22.53,,,,,,,fee schedule,Payment capped at billed charges,27.94,,,,,,,fee schedule,Payment capped at billed charges,23.7,,,,,,,fee schedule,Payment capped at billed charges,36,,,,,,,fee schedule,,50,,,,,,,fee schedule,Payment capped at billed charges,21.78,,,,,,,fee schedule,Payment capped at billed charges,39.37,,,,,,,fee schedule,Payment capped at billed charges,21.15,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,51.58683699,,,,,,,fee schedule,Payment capped at billed charges,21.78,,,,,,,fee schedule,Payment capped at billed charges,21.55,,,,,,,fee schedule,,46.8,,,,,,,percent of total billed charges,
OT UNLISTED PM R,96000666,CDM,0430,RC,97139,CPT,11,Local,GO  ,outpatient,professional,,,65,150,13.08,90,cash pricing is a case rate for all services provided during a visit,65,,,,,,,fee schedule,,22.75,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,13.51,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,52,,,,,,,fee schedule,payment capped at 80% of billed charges,55.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,15.39,,,,,,,fee schedule,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,32.5,,,,,,,fee schedule,,42.85,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,31.6536,,,,,,,fee schedule,Payment capped at billed charges,13.2,,,,,,,fee schedule,Payment capped at billed charges,14.72,,,,,,,fee schedule,,42.25,,,,,,,percent of total billed charges,
OT MANUAL THER EA 15 MIN,96000674,CDM,0430,RC,97140,CPT,11,Local,GO  ,outpatient,professional,,,74,150,23.92,90,cash pricing is a case rate for all services provided during a visit,28.56,,,,,,,fee schedule,,28.67,,,,,,,fee schedule,,67.01,,,,,,,fee schedule,Payment capped at billed charges,23.92,,,,,,,fee schedule,,59.64,,,,,,,fee schedule,Payment capped at billed charges,49.59,,,,,,,fee schedule,Payment capped at billed charges,27.7,,,,,,,fee schedule,payment capped at 80% of billed charges,62.9,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,37.82,,,,,,,fee schedule,Payment capped at billed charges,31.51,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,37.13,,,,,,,fee schedule,Payment capped at billed charges,32.02,,,,,,,fee schedule,Payment capped at billed charges,25.62,,,,,,,fee schedule,,63.56,,,,,,,fee schedule,Payment capped at billed charges,28.95,,,,,,,fee schedule,Payment capped at billed charges,39.31,,,,,,,fee schedule,Payment capped at billed charges,28.1,,,,,,,fee schedule,Payment capped at billed charges,35.38,,,,,,,fee schedule,Payment capped at billed charges,66.10761063,,,,,,,fee schedule,Payment capped at billed charges,28.95,,,,,,,fee schedule,Payment capped at billed charges,25.8,,,,,,,fee schedule,,48.1,,,,,,,percent of total billed charges,
OT THERAPEUTIC PROCEDURES GRP,96000682,CDM,0433,RC,97150,CPT,11,Local,GO  ,outpatient,professional,,,46,150,16.42,90,cash pricing is a case rate for all services provided during a visit,18.36,,,,,,,fee schedule,,18.43,,,,,,,fee schedule,,44.65,,,,,,,fee schedule,Payment capped at billed charges,18.62,,,,,,,fee schedule,,39.74,,,,,,,fee schedule,Payment capped at billed charges,33.04,,,,,,,fee schedule,Payment capped at billed charges,17.81,,,,,,,fee schedule,payment capped at 80% of billed charges,39.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,24.24,,,,,,,fee schedule,Payment capped at billed charges,20.2,,,,,,,fee schedule,Payment capped at billed charges,20.99,,,,,,,fee schedule,Payment capped at billed charges,23.87,,,,,,,fee schedule,Payment capped at billed charges,20.53,,,,,,,fee schedule,Payment capped at billed charges,16.42,,,,,,,fee schedule,,41.18,,,,,,,fee schedule,Payment capped at billed charges,18.61,,,,,,,fee schedule,Payment capped at billed charges,23.94,,,,,,,fee schedule,Payment capped at billed charges,18.07,,,,,,,fee schedule,Payment capped at billed charges,21.54,,,,,,,fee schedule,Payment capped at billed charges,43.27335799,,,,,,,fee schedule,Payment capped at billed charges,18.61,,,,,,,fee schedule,Payment capped at billed charges,20.08,,,,,,,fee schedule,,29.9,,,,,,,percent of total billed charges,
OT EVAL LOW COMPLEX,96000690,CDM,0434,RC,97165,CPT,11,Local,GO  ,outpatient,professional,,,262,150,68.35,252.23,cash pricing is a case rate for all services provided during a visit,105.85,,,,,,,fee schedule,,106.24,,,,,,,fee schedule,,252.23,,,,,,,fee schedule,Payment capped at billed charges,68.35,,,,,,,fee schedule,,224.48,,,,,,,fee schedule,Payment capped at billed charges,186.65,,,,,,,fee schedule,Payment capped at billed charges,102.68,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,140.32,,,,,,,fee schedule,Payment capped at billed charges,116.92,,,,,,,fee schedule,Payment capped at billed charges,77.06,,,,,,,fee schedule,Payment capped at billed charges,137.6,,,,,,,fee schedule,Payment capped at billed charges,118.82,,,,,,,fee schedule,Payment capped at billed charges,95.06,,,,,,,fee schedule,,237.54,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,150.06,,,,,,,fee schedule,Payment capped at billed charges,104.16,,,,,,,fee schedule,Payment capped at billed charges,135.05,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,73.71,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
OT EVAL MOD COMPLEX,96000708,CDM,0434,RC,97166,CPT,11,Local,GO  ,outpatient,professional,,,262,150,68.35,252.23,cash pricing is a case rate for all services provided during a visit,105.85,,,,,,,fee schedule,,106.24,,,,,,,fee schedule,,252.23,,,,,,,fee schedule,Payment capped at billed charges,68.35,,,,,,,fee schedule,,224.48,,,,,,,fee schedule,Payment capped at billed charges,186.65,,,,,,,fee schedule,Payment capped at billed charges,102.68,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,140.32,,,,,,,fee schedule,Payment capped at billed charges,116.92,,,,,,,fee schedule,Payment capped at billed charges,77.06,,,,,,,fee schedule,Payment capped at billed charges,137.6,,,,,,,fee schedule,Payment capped at billed charges,118.82,,,,,,,fee schedule,Payment capped at billed charges,95.06,,,,,,,fee schedule,,237.54,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,146.77,,,,,,,fee schedule,Payment capped at billed charges,104.16,,,,,,,fee schedule,Payment capped at billed charges,132.1,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,73.71,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
OT EVAL HIGH COMPLEX,96000716,CDM,0434,RC,97167,CPT,11,Local,GO  ,outpatient,professional,,,262,150,68.35,252.23,cash pricing is a case rate for all services provided during a visit,105.85,,,,,,,fee schedule,,106.24,,,,,,,fee schedule,,252.23,,,,,,,fee schedule,Payment capped at billed charges,68.35,,,,,,,fee schedule,,224.48,,,,,,,fee schedule,Payment capped at billed charges,186.65,,,,,,,fee schedule,Payment capped at billed charges,102.68,,,,,,,fee schedule,payment capped at 80% of billed charges,222.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,140.32,,,,,,,fee schedule,Payment capped at billed charges,116.92,,,,,,,fee schedule,Payment capped at billed charges,77.06,,,,,,,fee schedule,Payment capped at billed charges,137.6,,,,,,,fee schedule,Payment capped at billed charges,118.82,,,,,,,fee schedule,Payment capped at billed charges,95.06,,,,,,,fee schedule,,237.54,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,153.49,,,,,,,fee schedule,Payment capped at billed charges,104.16,,,,,,,fee schedule,Payment capped at billed charges,138.15,,,,,,,fee schedule,Payment capped at billed charges,245.1502794,,,,,,,fee schedule,Payment capped at billed charges,107.28,,,,,,,fee schedule,Payment capped at billed charges,73.71,,,,,,,fee schedule,,170.3,,,,,,,percent of total billed charges,
OT RE-EVAL EST PLAN CARE,96000724,CDM,0434,RC,97168,CPT,11,Local,GO  ,outpatient,professional,,,183,150,45.23,175.27,cash pricing is a case rate for all services provided during a visit,73.39,,,,,,,fee schedule,,73.66,,,,,,,fee schedule,,175.27,,,,,,,fee schedule,Payment capped at billed charges,45.23,,,,,,,fee schedule,,155.99,,,,,,,fee schedule,Payment capped at billed charges,129.7,,,,,,,fee schedule,Payment capped at billed charges,71.19,,,,,,,fee schedule,payment capped at 80% of billed charges,155.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,97.56,,,,,,,fee schedule,Payment capped at billed charges,81.29,,,,,,,fee schedule,Payment capped at billed charges,50.99,,,,,,,fee schedule,Payment capped at billed charges,95.41,,,,,,,fee schedule,Payment capped at billed charges,82.61,,,,,,,fee schedule,Payment capped at billed charges,66.09,,,,,,,fee schedule,,164.63,,,,,,,fee schedule,Payment capped at billed charges,74.38,,,,,,,fee schedule,Payment capped at billed charges,101.72,,,,,,,fee schedule,Payment capped at billed charges,72.22,,,,,,,fee schedule,Payment capped at billed charges,91.56,,,,,,,fee schedule,Payment capped at billed charges,169.8677094,,,,,,,fee schedule,Payment capped at billed charges,74.38,,,,,,,fee schedule,Payment capped at billed charges,48.77,,,,,,,fee schedule,,118.95,,,,,,,percent of total billed charges,
OT THER ACT EA 15 MIN,96000732,CDM,0430,RC,97530,CPT,11,Local,GO  ,outpatient,professional,,,102,150,31.17,92.44,cash pricing is a case rate for all services provided during a visit,36.56,,,,,,,fee schedule,,36.69,,,,,,,fee schedule,,92.44,,,,,,,fee schedule,Payment capped at billed charges,31.17,,,,,,,fee schedule,,82.27,,,,,,,fee schedule,Payment capped at billed charges,68.41,,,,,,,fee schedule,Payment capped at billed charges,35.46,,,,,,,fee schedule,payment capped at 80% of billed charges,86.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,48.77,,,,,,,fee schedule,Payment capped at billed charges,40.64,,,,,,,fee schedule,Payment capped at billed charges,35.14,,,,,,,fee schedule,Payment capped at billed charges,47.53,,,,,,,fee schedule,Payment capped at billed charges,41.3,,,,,,,fee schedule,Payment capped at billed charges,33.03,,,,,,,fee schedule,,89.29,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,42.5,,,,,,,fee schedule,Payment capped at billed charges,35.98,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,91.25433935,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,33.62,,,,,,,fee schedule,,66.3,,,,,,,percent of total billed charges,
OT SENSORY INTEGRATION EA15MIN,96000740,CDM,0430,RC,97533,CPT,11,Local,GO  ,outpatient,professional,,,172,150,23.32,159.83,cash pricing is a case rate for all services provided during a visit,64.38,,,,,,,fee schedule,,64.62,,,,,,,fee schedule,,159.83,,,,,,,fee schedule,Payment capped at billed charges,23.32,,,,,,,fee schedule,,142.25,,,,,,,fee schedule,Payment capped at billed charges,118.27,,,,,,,fee schedule,Payment capped at billed charges,62.45,,,,,,,fee schedule,payment capped at 80% of billed charges,146.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,86.8,,,,,,,fee schedule,Payment capped at billed charges,72.32,,,,,,,fee schedule,Payment capped at billed charges,26.29,,,,,,,fee schedule,Payment capped at billed charges,83.69,,,,,,,fee schedule,Payment capped at billed charges,73.5,,,,,,,fee schedule,Payment capped at billed charges,86,,,,,,,fee schedule,,158.57,,,,,,,fee schedule,Payment capped at billed charges,65.25,,,,,,,fee schedule,Payment capped at billed charges,55.21,,,,,,,fee schedule,Payment capped at billed charges,63.35,,,,,,,fee schedule,Payment capped at billed charges,49.69,,,,,,,fee schedule,Payment capped at billed charges,157.407535,,,,,,,fee schedule,Payment capped at billed charges,65.25,,,,,,,fee schedule,Payment capped at billed charges,25.15,,,,,,,fee schedule,,111.8,,,,,,,percent of total billed charges,
OT ADL SELF CARE/HOME MGT 15M,96000757,CDM,0430,RC,97535,CPT,11,Local,GO  ,outpatient,professional,,,86,150,27.98,90,cash pricing is a case rate for all services provided during a visit,33.75,,,,,,,fee schedule,,33.87,,,,,,,fee schedule,,81.77,,,,,,,fee schedule,Payment capped at billed charges,27.98,,,,,,,fee schedule,,72.78,,,,,,,fee schedule,Payment capped at billed charges,60.51,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,payment capped at 80% of billed charges,73.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.89,,,,,,,fee schedule,Payment capped at billed charges,37.4,,,,,,,fee schedule,Payment capped at billed charges,31.54,,,,,,,fee schedule,Payment capped at billed charges,43.88,,,,,,,fee schedule,Payment capped at billed charges,38.01,,,,,,,fee schedule,Payment capped at billed charges,30.41,,,,,,,fee schedule,,77.97,,,,,,,fee schedule,Payment capped at billed charges,34.21,,,,,,,fee schedule,Payment capped at billed charges,39.26,,,,,,,fee schedule,Payment capped at billed charges,33.21,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,80.28765525,,,,,,,fee schedule,Payment capped at billed charges,34.21,,,,,,,fee schedule,Payment capped at billed charges,30.17,,,,,,,fee schedule,,55.9,,,,,,,percent of total billed charges,
OT COM/WORK REINTEG 15M,96000765,CDM,0430,RC,97537,CPT,11,Local,GO  ,outpatient,professional,,,84,150,24.2,90,cash pricing is a case rate for all services provided during a visit,33.35,,,,,,,fee schedule,,33.47,,,,,,,fee schedule,,78.84,,,,,,,fee schedule,Payment capped at billed charges,24.2,,,,,,,fee schedule,,70.17,,,,,,,fee schedule,Payment capped at billed charges,58.34,,,,,,,fee schedule,Payment capped at billed charges,67.2,,,,,,,fee schedule,payment capped at 80% of billed charges,71.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,44.24,,,,,,,fee schedule,Payment capped at billed charges,36.86,,,,,,,fee schedule,Payment capped at billed charges,27.29,,,,,,,fee schedule,Payment capped at billed charges,43.36,,,,,,,fee schedule,Payment capped at billed charges,37.46,,,,,,,fee schedule,Payment capped at billed charges,29.97,,,,,,,fee schedule,,74.98,,,,,,,fee schedule,Payment capped at billed charges,33.8,,,,,,,fee schedule,Payment capped at billed charges,39.26,,,,,,,fee schedule,Payment capped at billed charges,32.82,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,77.62208809,,,,,,,fee schedule,Payment capped at billed charges,33.8,,,,,,,fee schedule,Payment capped at billed charges,26.1,,,,,,,fee schedule,,54.6,,,,,,,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN,96000773,CDM,0430,RC,97542,CPT,11,Local,GO  ,outpatient,professional,,,83,150,27.74,90,cash pricing is a case rate for all services provided during a visit,32.3,,,,,,,fee schedule,,32.42,,,,,,,fee schedule,,,,,,,,,,service not payable,27.74,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,31.33,,,,,,,fee schedule,payment capped at 80% of billed charges,70.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,42.82,,,,,,,fee schedule,Payment capped at billed charges,35.68,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,41.99,,,,,,,fee schedule,Payment capped at billed charges,36.26,,,,,,,fee schedule,Payment capped at billed charges,29,,,,,,,fee schedule,,74.98,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,Payment capped at billed charges,32.56,,,,,,,fee schedule,Payment capped at billed charges,31.78,,,,,,,fee schedule,Payment capped at billed charges,29.68,,,,,,,fee schedule,Payment capped at billed charges,77.62208809,,,,,,,fee schedule,Payment capped at billed charges,32.74,,,,,,,fee schedule,Payment capped at billed charges,32.3,,,,,,,fee schedule,,53.95,,,,,,,percent of total billed charges,
OT WORK HARDENING,96000781,CDM,0430,RC,97545,CPT,11,Local,GO  ,outpatient,professional,,,413,150,10.61,413,cash pricing is a case rate for all services provided during a visit,248.29,,,,,,,fee schedule,,144.55,,,,,,,fee schedule,,413,,,,,,,fee schedule,Payment capped at billed charges,10.61,,,,,,,fee schedule,,376.98,,,,,,,fee schedule,Payment capped at billed charges,313.44,,,,,,,fee schedule,Payment capped at billed charges,330.4,,,,,,,fee schedule,payment capped at 80% of billed charges,351.05,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,12.08,,,,,,,fee schedule,Payment capped at billed charges,268.45,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,206.5,,,,,,,fee schedule,,412.96,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,362.8,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,326.53,,,,,,,fee schedule,Payment capped at billed charges,305.5008,,,,,,,fee schedule,Payment capped at billed charges,127.43,,,,,,,fee schedule,Payment capped at billed charges,11.55,,,,,,,fee schedule,,268.45,,,,,,,percent of total billed charges,
OT WORK HARDENING ADD ON,96000799,CDM,0430,RC,97546,CPT,11,Local,GO  ,outpatient,professional,,,184,150,50.29,181.41,cash pricing is a case rate for all services provided during a visit,73.41,,,,,,,fee schedule,,64.4,,,,,,,fee schedule,,168.91,,,,,,,fee schedule,Payment capped at billed charges,62.56,,,,,,,fee schedule,,150.33,,,,,,,fee schedule,Payment capped at billed charges,124.99,,,,,,,fee schedule,Payment capped at billed charges,147.2,,,,,,,fee schedule,payment capped at 80% of billed charges,156.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,119.6,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,92,,,,,,,fee schedule,,163.16,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,181.41,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,163.27,,,,,,,fee schedule,Payment capped at billed charges,121.7018,,,,,,,fee schedule,Payment capped at billed charges,50.76,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,119.6,,,,,,,percent of total billed charges,
OT SELECT DEBRID 1ST20SQCMLESS,96000807,CDM,0430,RC,97597,CPT,11,Local,GO  ,outpatient,professional,,,273,150,60.42,258.99,cash pricing is a case rate for all services provided during a visit,103.19,,,,,,,fee schedule,,103.57,,,,,,,fee schedule,,258.99,,,,,,,fee schedule,Payment capped at billed charges,60.42,,,,,,,fee schedule,,230.5,,,,,,,fee schedule,Payment capped at billed charges,191.65,,,,,,,fee schedule,Payment capped at billed charges,100.09,,,,,,,fee schedule,payment capped at 80% of billed charges,232.05,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,138.73,,,,,,,fee schedule,Payment capped at billed charges,115.59,,,,,,,fee schedule,Payment capped at billed charges,68.79,,,,,,,fee schedule,Payment capped at billed charges,134.15,,,,,,,fee schedule,Payment capped at billed charges,117.47,,,,,,,fee schedule,Payment capped at billed charges,93.98,,,,,,,fee schedule,,251.6,,,,,,,fee schedule,Payment capped at billed charges,104.59,,,,,,,fee schedule,Payment capped at billed charges,105.38,,,,,,,fee schedule,Payment capped at billed charges,101.54,,,,,,,fee schedule,Payment capped at billed charges,94.83,,,,,,,fee schedule,Payment capped at billed charges,250.0842828,,,,,,,fee schedule,Payment capped at billed charges,104.59,,,,,,,fee schedule,Payment capped at billed charges,65.8,,,,,,,fee schedule,,177.45,,,,,,,percent of total billed charges,
OT SELECT DEBRIDE EA ADD20SQCM,96000815,CDM,0430,RC,97598,CPT,11,Local,GO  ,outpatient,professional,,,138,150,25.94,133.51,cash pricing is a case rate for all services provided during a visit,46.16,,,,,,,fee schedule,,46.33,,,,,,,fee schedule,,113.77,,,,,,,fee schedule,Payment capped at billed charges,25.94,,,,,,,fee schedule,,101.26,,,,,,,fee schedule,Payment capped at billed charges,84.19,,,,,,,fee schedule,Payment capped at billed charges,44.78,,,,,,,fee schedule,payment capped at 80% of billed charges,117.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,61.31,,,,,,,fee schedule,Payment capped at billed charges,51.08,,,,,,,fee schedule,Payment capped at billed charges,29.53,,,,,,,fee schedule,Payment capped at billed charges,60.01,,,,,,,fee schedule,Payment capped at billed charges,51.91,,,,,,,fee schedule,Payment capped at billed charges,41.53,,,,,,,fee schedule,,110.28,,,,,,,fee schedule,Payment capped at billed charges,46.78,,,,,,,fee schedule,Payment capped at billed charges,133.51,,,,,,,fee schedule,Payment capped at billed charges,45.42,,,,,,,fee schedule,Payment capped at billed charges,120.17,,,,,,,fee schedule,Payment capped at billed charges,111.1441061,,,,,,,fee schedule,Payment capped at billed charges,46.78,,,,,,,fee schedule,Payment capped at billed charges,28.25,,,,,,,fee schedule,,89.7,,,,,,,percent of total billed charges,
OT PHYSICAL PERF TEST EA 15MIN,96000823,CDM,0430,RC,97750,CPT,11,Local,GO  ,outpatient,professional,,,90,150,26.23,90,cash pricing is a case rate for all services provided during a visit,35.15,,,,,,,fee schedule,,35.28,,,,,,,fee schedule,,85.3,,,,,,,fee schedule,Payment capped at billed charges,26.23,,,,,,,fee schedule,,75.92,,,,,,,fee schedule,Payment capped at billed charges,63.12,,,,,,,fee schedule,Payment capped at billed charges,34.1,,,,,,,fee schedule,payment capped at 80% of billed charges,76.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,46.8,,,,,,,fee schedule,Payment capped at billed charges,38.99,,,,,,,fee schedule,Payment capped at billed charges,29.58,,,,,,,fee schedule,Payment capped at billed charges,45.7,,,,,,,fee schedule,Payment capped at billed charges,39.63,,,,,,,fee schedule,Payment capped at billed charges,31.7,,,,,,,fee schedule,,79.68,,,,,,,fee schedule,Payment capped at billed charges,35.63,,,,,,,fee schedule,Payment capped at billed charges,60.32,,,,,,,fee schedule,Payment capped at billed charges,34.59,,,,,,,fee schedule,Payment capped at billed charges,54.58,,,,,,,fee schedule,Payment capped at billed charges,82.80719568,,,,,,,fee schedule,Payment capped at billed charges,35.63,,,,,,,fee schedule,Payment capped at billed charges,28.29,,,,,,,fee schedule,,58.5,,,,,,,percent of total billed charges,
OT EVAL ENVIR ASSES,96000831,CDM,0430,RC,97755,CPT,11,Local,GO  ,outpatient,professional,,,100,150,28.23,95.04,cash pricing is a case rate for all services provided during a visit,39.43,,,,,,,fee schedule,,39.58,,,,,,,fee schedule,,95.04,,,,,,,fee schedule,Payment capped at billed charges,28.23,,,,,,,fee schedule,,84.59,,,,,,,fee schedule,Payment capped at billed charges,70.33,,,,,,,fee schedule,Payment capped at billed charges,38.25,,,,,,,fee schedule,payment capped at 80% of billed charges,85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,52.08,,,,,,,fee schedule,Payment capped at billed charges,43.39,,,,,,,fee schedule,Payment capped at billed charges,31.83,,,,,,,fee schedule,Payment capped at billed charges,51.26,,,,,,,fee schedule,Payment capped at billed charges,44.1,,,,,,,fee schedule,Payment capped at billed charges,35.28,,,,,,,fee schedule,,88.72,,,,,,,fee schedule,Payment capped at billed charges,39.96,,,,,,,fee schedule,Payment capped at billed charges,72.04,,,,,,,fee schedule,Payment capped at billed charges,38.8,,,,,,,fee schedule,Payment capped at billed charges,64.84,,,,,,,fee schedule,Payment capped at billed charges,93.91063496,,,,,,,fee schedule,Payment capped at billed charges,39.96,,,,,,,fee schedule,Payment capped at billed charges,30.45,,,,,,,fee schedule,,65,,,,,,,percent of total billed charges,
OT ORTH FIT/TRAIN INIT EA15MIN,96000849,CDM,0430,RC,97760,CPT,11,Local,GO  ,outpatient,professional,,,130,150,42.87,119.5170774,cash pricing is a case rate for all services provided during a visit,48.65,,,,,,,fee schedule,,48.83,,,,,,,fee schedule,,,,,,,,,,service not payable,42.87,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,47.19,,,,,,,fee schedule,payment capped at 80% of billed charges,110.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,65.17,,,,,,,fee schedule,Payment capped at billed charges,54.3,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,63.24,,,,,,,fee schedule,Payment capped at billed charges,55.19,,,,,,,fee schedule,Payment capped at billed charges,44.15,,,,,,,fee schedule,,117.81,,,,,,,fee schedule,Payment capped at billed charges,49.31,,,,,,,fee schedule,Payment capped at billed charges,53.68,,,,,,,fee schedule,Payment capped at billed charges,47.87,,,,,,,fee schedule,Payment capped at billed charges,48.3,,,,,,,fee schedule,Payment capped at billed charges,119.5170774,,,,,,,fee schedule,Payment capped at billed charges,49.31,,,,,,,fee schedule,Payment capped at billed charges,48.65,,,,,,,fee schedule,,84.5,,,,,,,percent of total billed charges,
OT PROSTH TRAIN INIT EA 15MIN,96000856,CDM,0430,RC,97761,CPT,11,Local,GO  ,outpatient,professional,,,111,150,36.5,102.7201412,cash pricing is a case rate for all services provided during a visit,42.72,,,,,,,fee schedule,,42.88,,,,,,,fee schedule,,,,,,,,,,service not payable,36.5,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,41.44,,,,,,,fee schedule,payment capped at 80% of billed charges,94.35,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,57.05,,,,,,,fee schedule,Payment capped at billed charges,47.54,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,55.54,,,,,,,fee schedule,Payment capped at billed charges,48.31,,,,,,,fee schedule,Payment capped at billed charges,38.65,,,,,,,fee schedule,,99.72,,,,,,,fee schedule,Payment capped at billed charges,43.3,,,,,,,fee schedule,Payment capped at billed charges,53.33,,,,,,,fee schedule,Payment capped at billed charges,42.04,,,,,,,fee schedule,Payment capped at billed charges,48.01,,,,,,,fee schedule,Payment capped at billed charges,102.7201412,,,,,,,fee schedule,Payment capped at billed charges,43.3,,,,,,,fee schedule,Payment capped at billed charges,42.72,,,,,,,fee schedule,,72.15,,,,,,,percent of total billed charges,
OT ORTH/PROS SUBS ENC EA15MIN,96000864,CDM,0430,RC,97763,CPT,11,Local,GO  ,outpatient,professional,,,144,150,47.77,131.86,cash pricing is a case rate for all services provided during a visit,53.22,,,,,,,fee schedule,,53.42,,,,,,,fee schedule,,,,,,,,,,service not payable,47.77,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,51.63,,,,,,,fee schedule,payment capped at 80% of billed charges,122.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,71.5,,,,,,,fee schedule,Payment capped at billed charges,59.57,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,69.19,,,,,,,fee schedule,Payment capped at billed charges,60.54,,,,,,,fee schedule,Payment capped at billed charges,72,,,,,,,fee schedule,,131.86,,,,,,,fee schedule,Payment capped at billed charges,53.94,,,,,,,fee schedule,Payment capped at billed charges,75.2,,,,,,,fee schedule,Payment capped at billed charges,52.37,,,,,,,fee schedule,Payment capped at billed charges,67.68,,,,,,,fee schedule,Payment capped at billed charges,131.3722839,,,,,,,fee schedule,Payment capped at billed charges,53.94,,,,,,,fee schedule,Payment capped at billed charges,53.22,,,,,,,fee schedule,,93.6,,,,,,,percent of total billed charges,
OT DRIVING EVAL,96000872,CDM,0430,RC,97799,CPT,11,Local,GO  ,outpatient,professional,,,350,150,20.2,350,cash pricing is a case rate for all services provided during a visit,350,,,,,,,fee schedule,,122.5,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,20.2,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,227.5,,,,,,,fee schedule,Payment capped at billed charges,280,,,,,,,fee schedule,payment capped at 80% of billed charges,297.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,23,,,,,,,fee schedule,Payment capped at billed charges,227.5,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,175,,,,,,,fee schedule,,227.5,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,service not payable,,,,,,,,,service not payable,22,,,,,,,fee schedule,,227.5,,,,,,,percent of total billed charges,
SP BIOFEEDBACK TRAINING,96000880,CDM,0440,RC,90901,CPT,11,Local,GN  ,outpatient,professional,,,141,150,28.82,120.85,cash pricing is a case rate for all services provided during a visit,41.92,,,,,,,fee schedule,,42.07,,,,,,,fee schedule,,120.85,,,,,,,fee schedule,Payment capped at billed charges,28.82,,,,,,,fee schedule,,107.56,,,,,,,fee schedule,Payment capped at billed charges,89.43,,,,,,,fee schedule,Payment capped at billed charges,40.66,,,,,,,fee schedule,payment capped at 80% of billed charges,119.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,56.09,,,,,,,fee schedule,Payment capped at billed charges,46.73,,,,,,,fee schedule,Payment capped at billed charges,32.81,,,,,,,fee schedule,Payment capped at billed charges,41.92,,,,,,,fee schedule,Payment capped at billed charges,47.49,,,,,,,fee schedule,Payment capped at billed charges,70.5,,,,,,,fee schedule,,120.5,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,80.01,,,,,,,fee schedule,Payment capped at billed charges,41.25,,,,,,,fee schedule,Payment capped at billed charges,72,,,,,,,fee schedule,Payment capped at billed charges,100.638681,,,,,,,fee schedule,Payment capped at billed charges,42.49,,,,,,,fee schedule,Payment capped at billed charges,31.38,,,,,,,fee schedule,,91.65,,,,,,,percent of total billed charges,
SP COMM/COG/LANG TX,96000898,CDM,0440,RC,92507,CPT,11,Local,GN  ,outpatient,professional,,,275,150,65.27,233.75,cash pricing is a case rate for all services provided during a visit,78.68,,,,,,,fee schedule,,78.97,,,,,,,fee schedule,,218.8,,,,,,,fee schedule,Payment capped at billed charges,65.27,,,,,,,fee schedule,,194.73,,,,,,,fee schedule,Payment capped at billed charges,161.91,,,,,,,fee schedule,Payment capped at billed charges,76.32,,,,,,,fee schedule,payment capped at 80% of billed charges,233.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,103.85,,,,,,,fee schedule,Payment capped at billed charges,86.53,,,,,,,fee schedule,Payment capped at billed charges,73.59,,,,,,,fee schedule,Payment capped at billed charges,78.68,,,,,,,fee schedule,Payment capped at billed charges,87.94,,,,,,,fee schedule,Payment capped at billed charges,70.35,,,,,,,fee schedule,,218.78,,,,,,,fee schedule,Payment capped at billed charges,79.74,,,,,,,fee schedule,Payment capped at billed charges,73.86,,,,,,,fee schedule,Payment capped at billed charges,77.42,,,,,,,fee schedule,Payment capped at billed charges,66.47,,,,,,,fee schedule,Payment capped at billed charges,185.8495229,,,,,,,fee schedule,Payment capped at billed charges,79.74,,,,,,,fee schedule,Payment capped at billed charges,70.39,,,,,,,fee schedule,,178.75,,,,,,,percent of total billed charges,
SP LANGUAGE TX GROUP,96000906,CDM,0443,RC,92508,CPT,11,Local,GN  ,outpatient,professional,,,68,150,22.43,90,cash pricing is a case rate for all services provided during a visit,24.91,,,,,,,fee schedule,,25,,,,,,,fee schedule,,68,,,,,,,fee schedule,Payment capped at billed charges,26.19,,,,,,,fee schedule,,62.93,,,,,,,fee schedule,Payment capped at billed charges,52.33,,,,,,,fee schedule,Payment capped at billed charges,24.16,,,,,,,fee schedule,payment capped at 80% of billed charges,57.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,33.11,,,,,,,fee schedule,Payment capped at billed charges,27.59,,,,,,,fee schedule,Payment capped at billed charges,29.49,,,,,,,fee schedule,Payment capped at billed charges,24.91,,,,,,,fee schedule,Payment capped at billed charges,28.04,,,,,,,fee schedule,Payment capped at billed charges,22.43,,,,,,,fee schedule,,68,,,,,,,fee schedule,Payment capped at billed charges,25.25,,,,,,,fee schedule,Payment capped at billed charges,43.74,,,,,,,fee schedule,Payment capped at billed charges,24.51,,,,,,,fee schedule,Payment capped at billed charges,39.35,,,,,,,fee schedule,Payment capped at billed charges,58.19589827,,,,,,,fee schedule,Payment capped at billed charges,25.25,,,,,,,fee schedule,Payment capped at billed charges,28.2,,,,,,,fee schedule,,44.2,,,,,,,percent of total billed charges,
SP EVAL OF SPEECH FLUENCY,96000914,CDM,0444,RC,92521,CPT,11,Local,GN  ,outpatient,professional,,,378,150,90,378,cash pricing is a case rate for all services provided during a visit,137.04,,,,,,,fee schedule,,137.54,,,,,,,fee schedule,,378,,,,,,,fee schedule,Payment capped at billed charges,93.18,,,,,,,fee schedule,,339.52,,,,,,,fee schedule,Payment capped at billed charges,282.3,,,,,,,fee schedule,Payment capped at billed charges,132.93,,,,,,,fee schedule,payment capped at 80% of billed charges,321.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,180.98,,,,,,,fee schedule,Payment capped at billed charges,150.8,,,,,,,fee schedule,Payment capped at billed charges,105.05,,,,,,,fee schedule,Payment capped at billed charges,137.04,,,,,,,fee schedule,Payment capped at billed charges,153.25,,,,,,,fee schedule,Payment capped at billed charges,122.6,,,,,,,fee schedule,,378,,,,,,,fee schedule,Payment capped at billed charges,138.89,,,,,,,fee schedule,Payment capped at billed charges,176.64,,,,,,,fee schedule,Payment capped at billed charges,134.85,,,,,,,fee schedule,Payment capped at billed charges,158.98,,,,,,,fee schedule,Payment capped at billed charges,322.7144204,,,,,,,fee schedule,Payment capped at billed charges,138.89,,,,,,,fee schedule,Payment capped at billed charges,100.49,,,,,,,fee schedule,,245.7,,,,,,,percent of total billed charges,
SP EVALUATE SPEECH PRODUCTION,96000922,CDM,0444,RC,92522,CPT,11,Local,GN  ,outpatient,professional,,,316,150,75.48,316,cash pricing is a case rate for all services provided during a visit,114.01,,,,,,,fee schedule,,114.43,,,,,,,fee schedule,,316,,,,,,,fee schedule,Payment capped at billed charges,75.48,,,,,,,fee schedule,,283.71,,,,,,,fee schedule,Payment capped at billed charges,235.9,,,,,,,fee schedule,Payment capped at billed charges,110.58,,,,,,,fee schedule,payment capped at 80% of billed charges,268.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,150.19,,,,,,,fee schedule,Payment capped at billed charges,125.14,,,,,,,fee schedule,Payment capped at billed charges,85.1,,,,,,,fee schedule,Payment capped at billed charges,114.01,,,,,,,fee schedule,Payment capped at billed charges,127.18,,,,,,,fee schedule,Payment capped at billed charges,101.75,,,,,,,fee schedule,,316,,,,,,,fee schedule,Payment capped at billed charges,115.55,,,,,,,fee schedule,Payment capped at billed charges,148.01,,,,,,,fee schedule,Payment capped at billed charges,112.19,,,,,,,fee schedule,Payment capped at billed charges,133.21,,,,,,,fee schedule,Payment capped at billed charges,269.8550648,,,,,,,fee schedule,Payment capped at billed charges,115.55,,,,,,,fee schedule,Payment capped at billed charges,81.4,,,,,,,fee schedule,,205.4,,,,,,,percent of total billed charges,
SP SOUND LANG COMPREHEN,96000930,CDM,0444,RC,92523,CPT,11,Local,GN  ,outpatient,professional,,,644,150,90,644,cash pricing is a case rate for all services provided during a visit,234.49,,,,,,,fee schedule,,235.35,,,,,,,fee schedule,,644,,,,,,,fee schedule,Payment capped at billed charges,157.05,,,,,,,fee schedule,,582.06,,,,,,,fee schedule,Payment capped at billed charges,483.96,,,,,,,fee schedule,Payment capped at billed charges,227.46,,,,,,,fee schedule,payment capped at 80% of billed charges,547.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,309.48,,,,,,,fee schedule,Payment capped at billed charges,257.87,,,,,,,fee schedule,Payment capped at billed charges,177.07,,,,,,,fee schedule,Payment capped at billed charges,234.49,,,,,,,fee schedule,Payment capped at billed charges,262.06,,,,,,,fee schedule,Payment capped at billed charges,209.64,,,,,,,fee schedule,,644,,,,,,,fee schedule,Payment capped at billed charges,237.66,,,,,,,fee schedule,Payment capped at billed charges,301.29,,,,,,,fee schedule,Payment capped at billed charges,230.74,,,,,,,fee schedule,Payment capped at billed charges,271.14,,,,,,,fee schedule,Payment capped at billed charges,553.2952506,,,,,,,fee schedule,Payment capped at billed charges,237.66,,,,,,,fee schedule,Payment capped at billed charges,169.37,,,,,,,fee schedule,,418.6,,,,,,,percent of total billed charges,
SP EVAL OF VOICE/RESONANCE,96000948,CDM,0444,RC,92524,CPT,11,Local,GN  ,outpatient,professional,,,311,150,78.95,311,cash pricing is a case rate for all services provided during a visit,111.84,,,,,,,fee schedule,,112.25,,,,,,,fee schedule,,311,,,,,,,fee schedule,Payment capped at billed charges,78.95,,,,,,,fee schedule,,279.18,,,,,,,fee schedule,Payment capped at billed charges,232.12,,,,,,,fee schedule,Payment capped at billed charges,108.48,,,,,,,fee schedule,payment capped at 80% of billed charges,264.35,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,147.34,,,,,,,fee schedule,Payment capped at billed charges,122.76,,,,,,,fee schedule,Payment capped at billed charges,89.01,,,,,,,fee schedule,Payment capped at billed charges,111.84,,,,,,,fee schedule,Payment capped at billed charges,124.76,,,,,,,fee schedule,Payment capped at billed charges,99.81,,,,,,,fee schedule,,311,,,,,,,fee schedule,Payment capped at billed charges,113.35,,,,,,,fee schedule,Payment capped at billed charges,145.54,,,,,,,fee schedule,Payment capped at billed charges,110.05,,,,,,,fee schedule,Payment capped at billed charges,130.99,,,,,,,fee schedule,Payment capped at billed charges,266.4956776,,,,,,,fee schedule,Payment capped at billed charges,113.35,,,,,,,fee schedule,Payment capped at billed charges,85.14,,,,,,,fee schedule,,202.15,,,,,,,percent of total billed charges,
SP SWALLOW TX,96000955,CDM,0440,RC,92526,CPT,11,Local,GN  ,outpatient,professional,,,245,150,77.97,244.56,cash pricing is a case rate for all services provided during a visit,86.98,,,,,,,fee schedule,,87.3,,,,,,,fee schedule,,243.87,,,,,,,fee schedule,Payment capped at billed charges,82.47,,,,,,,fee schedule,,217.04,,,,,,,fee schedule,Payment capped at billed charges,180.46,,,,,,,fee schedule,Payment capped at billed charges,84.37,,,,,,,fee schedule,payment capped at 80% of billed charges,208.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,115.11,,,,,,,fee schedule,Payment capped at billed charges,95.91,,,,,,,fee schedule,Payment capped at billed charges,92.98,,,,,,,fee schedule,Payment capped at billed charges,86.98,,,,,,,fee schedule,Payment capped at billed charges,97.47,,,,,,,fee schedule,Payment capped at billed charges,77.97,,,,,,,fee schedule,,244.56,,,,,,,fee schedule,Payment capped at billed charges,88.16,,,,,,,fee schedule,Payment capped at billed charges,153.56,,,,,,,fee schedule,Payment capped at billed charges,85.59,,,,,,,fee schedule,Payment capped at billed charges,138.21,,,,,,,fee schedule,Payment capped at billed charges,206.6509908,,,,,,,fee schedule,Payment capped at billed charges,88.16,,,,,,,fee schedule,Payment capped at billed charges,88.94,,,,,,,fee schedule,,159.25,,,,,,,percent of total billed charges,
SP VOICE PROSTHESIS EVAL,96000963,CDM,0444,RC,92597,CPT,11,Local,GN  ,outpatient,professional,,,444,150,66.6,377.4,cash pricing is a case rate for all services provided during a visit,74.65,,,,,,,fee schedule,,74.92,,,,,,,fee schedule,,,,,,,,,,service not payable,71.32,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,72.41,,,,,,,fee schedule,payment capped at 80% of billed charges,377.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,98.32,,,,,,,fee schedule,Payment capped at billed charges,81.92,,,,,,,fee schedule,Payment capped at billed charges,80.41,,,,,,,fee schedule,Payment capped at billed charges,74.65,,,,,,,fee schedule,Payment capped at billed charges,83.25,,,,,,,fee schedule,Payment capped at billed charges,66.6,,,,,,,fee schedule,,205.76,,,,,,,fee schedule,Payment capped at billed charges,75.66,,,,,,,fee schedule,Payment capped at billed charges,176.58,,,,,,,fee schedule,Payment capped at billed charges,73.46,,,,,,,fee schedule,Payment capped at billed charges,158.93,,,,,,,fee schedule,Payment capped at billed charges,174.2863698,,,,,,,fee schedule,Payment capped at billed charges,75.66,,,,,,,fee schedule,Payment capped at billed charges,76.91,,,,,,,fee schedule,,288.6,,,,,,,percent of total billed charges,
SP EVAL-SP GEN DEV1ST HR,96000971,CDM,0444,RC,92607,CPT,11,Local,GN  ,outpatient,professional,,,527,150,90,447.95,cash pricing is a case rate for all services provided during a visit,127.24,,,,,,,fee schedule,,127.71,,,,,,,fee schedule,,358.44,,,,,,,fee schedule,Payment capped at billed charges,124.17,,,,,,,fee schedule,,319.01,,,,,,,fee schedule,Payment capped at billed charges,265.25,,,,,,,fee schedule,Payment capped at billed charges,123.42,,,,,,,fee schedule,payment capped at 80% of billed charges,447.95,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,168.75,,,,,,,fee schedule,Payment capped at billed charges,140.61,,,,,,,fee schedule,Payment capped at billed charges,140,,,,,,,fee schedule,Payment capped at billed charges,127.24,,,,,,,fee schedule,Payment capped at billed charges,142.89,,,,,,,fee schedule,Payment capped at billed charges,263.5,,,,,,,fee schedule,,358.27,,,,,,,fee schedule,Payment capped at billed charges,128.96,,,,,,,fee schedule,Payment capped at billed charges,216.15,,,,,,,fee schedule,Payment capped at billed charges,125.2,,,,,,,fee schedule,Payment capped at billed charges,194.53,,,,,,,fee schedule,Payment capped at billed charges,301.5907665,,,,,,,fee schedule,Payment capped at billed charges,128.96,,,,,,,fee schedule,Payment capped at billed charges,133.91,,,,,,,fee schedule,,342.55,,,,,,,percent of total billed charges,
SP EVAL-SP GEN DEVADDL 30 MIN,96000989,CDM,0444,RC,92608,CPT,11,Local,GN  ,outpatient,professional,,,275,150,38.19,233.75,cash pricing is a case rate for all services provided during a visit,50.09,,,,,,,fee schedule,,50.27,,,,,,,fee schedule,,140.98,,,,,,,fee schedule,Payment capped at billed charges,41.95,,,,,,,fee schedule,,125.47,,,,,,,fee schedule,Payment capped at billed charges,104.33,,,,,,,fee schedule,Payment capped at billed charges,48.6,,,,,,,fee schedule,payment capped at 80% of billed charges,233.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,66.48,,,,,,,fee schedule,Payment capped at billed charges,55.39,,,,,,,fee schedule,Payment capped at billed charges,47.76,,,,,,,fee schedule,Payment capped at billed charges,50.09,,,,,,,fee schedule,Payment capped at billed charges,56.29,,,,,,,fee schedule,Payment capped at billed charges,137.5,,,,,,,fee schedule,,142.48,,,,,,,fee schedule,Payment capped at billed charges,50.77,,,,,,,fee schedule,Payment capped at billed charges,42.42,,,,,,,fee schedule,Payment capped at billed charges,49.29,,,,,,,fee schedule,Payment capped at billed charges,38.19,,,,,,,fee schedule,Payment capped at billed charges,118.7166347,,,,,,,fee schedule,Payment capped at billed charges,50.77,,,,,,,fee schedule,Payment capped at billed charges,45.68,,,,,,,fee schedule,,178.75,,,,,,,percent of total billed charges,
SP TRAINING/FITTING SLP GEN DV,96000997,CDM,0440,RC,92609,CPT,11,Local,GN  ,outpatient,professional,,,306,150,87.99,301.34,cash pricing is a case rate for all services provided during a visit,106.28,,,,,,,fee schedule,,106.67,,,,,,,fee schedule,,,,,,,,,,service not payable,87.99,,,,,,,fee schedule,,,,,,,,,,service not payable,,,,,,,,,service not payable,103.09,,,,,,,fee schedule,payment capped at 80% of billed charges,260.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,141.01,,,,,,,fee schedule,Payment capped at billed charges,117.5,,,,,,,fee schedule,Payment capped at billed charges,99.2,,,,,,,fee schedule,Payment capped at billed charges,106.28,,,,,,,fee schedule,Payment capped at billed charges,119.41,,,,,,,fee schedule,Payment capped at billed charges,153,,,,,,,fee schedule,,301.34,,,,,,,fee schedule,Payment capped at billed charges,107.72,,,,,,,fee schedule,Payment capped at billed charges,117.03,,,,,,,fee schedule,Payment capped at billed charges,104.58,,,,,,,fee schedule,Payment capped at billed charges,105.33,,,,,,,fee schedule,Payment capped at billed charges,252.0637562,,,,,,,fee schedule,Payment capped at billed charges,107.72,,,,,,,fee schedule,Payment capped at billed charges,94.89,,,,,,,fee schedule,,198.9,,,,,,,percent of total billed charges,
SP CLINICAL SWALLOW EVAL,96001003,CDM,0444,RC,92610,CPT,11,Local,GN  ,outpatient,professional,,,273,150,82.24,269.82,cash pricing is a case rate for all services provided during a visit,87.82,,,,,,,fee schedule,,88.14,,,,,,,fee schedule,,246.34,,,,,,,fee schedule,Payment capped at billed charges,82.24,,,,,,,fee schedule,,219.24,,,,,,,fee schedule,Payment capped at billed charges,182.29,,,,,,,fee schedule,Payment capped at billed charges,85.19,,,,,,,fee schedule,payment capped at 80% of billed charges,232.05,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,116.27,,,,,,,fee schedule,Payment capped at billed charges,96.88,,,,,,,fee schedule,Payment capped at billed charges,93.64,,,,,,,fee schedule,Payment capped at billed charges,87.82,,,,,,,fee schedule,Payment capped at billed charges,98.46,,,,,,,fee schedule,Payment capped at billed charges,136.5,,,,,,,fee schedule,,246.34,,,,,,,fee schedule,Payment capped at billed charges,89.01,,,,,,,fee schedule,Payment capped at billed charges,269.82,,,,,,,fee schedule,Payment capped at billed charges,86.41,,,,,,,fee schedule,Payment capped at billed charges,242.84,,,,,,,fee schedule,Payment capped at billed charges,206.8456931,,,,,,,fee schedule,Payment capped at billed charges,89.01,,,,,,,fee schedule,Payment capped at billed charges,89.57,,,,,,,fee schedule,,177.45,,,,,,,percent of total billed charges,
SP MOD BARIUM SWALLOWING STUDY,96001011,CDM,0440,RC,92611,CPT,11,Local,GN  ,outpatient,professional,,,264,150,86.23,264,cash pricing is a case rate for all services provided during a visit,93.75,,,,,,,fee schedule,,94.09,,,,,,,fee schedule,,264,,,,,,,fee schedule,Payment capped at billed charges,89.47,,,,,,,fee schedule,,236.98,,,,,,,fee schedule,Payment capped at billed charges,197.04,,,,,,,fee schedule,Payment capped at billed charges,90.94,,,,,,,fee schedule,payment capped at 80% of billed charges,224.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,124.17,,,,,,,fee schedule,Payment capped at billed charges,103.46,,,,,,,fee schedule,Payment capped at billed charges,101.87,,,,,,,fee schedule,Payment capped at billed charges,93.75,,,,,,,fee schedule,Payment capped at billed charges,105.15,,,,,,,fee schedule,Payment capped at billed charges,132,,,,,,,fee schedule,,264,,,,,,,fee schedule,Payment capped at billed charges,95.02,,,,,,,fee schedule,Payment capped at billed charges,95.83,,,,,,,fee schedule,Payment capped at billed charges,92.25,,,,,,,fee schedule,Payment capped at billed charges,86.23,,,,,,,fee schedule,Payment capped at billed charges,224.1402018,,,,,,,fee schedule,Payment capped at billed charges,95.02,,,,,,,fee schedule,Payment capped at billed charges,97.44,,,,,,,fee schedule,,171.6,,,,,,,percent of total billed charges,
SP FEES W/CINE OR VIDEO RECORD,96001029,CDM,0444,RC,92612,CPT,11,Local,GN  ,outpatient,professional,,,586,150,90,586,cash pricing is a case rate for all services provided during a visit,206.51,,,,,,,fee schedule,,207.27,,,,,,,fee schedule,,586,,,,,,,fee schedule,Payment capped at billed charges,151.49,,,,,,,fee schedule,,528.59,,,,,,,fee schedule,Payment capped at billed charges,439.5,,,,,,,fee schedule,Payment capped at billed charges,200.31,,,,,,,fee schedule,payment capped at 80% of billed charges,498.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,278.99,,,,,,,fee schedule,Payment capped at billed charges,232.46,,,,,,,fee schedule,Payment capped at billed charges,172.49,,,,,,,fee schedule,Payment capped at billed charges,206.51,,,,,,,fee schedule,Payment capped at billed charges,236.24,,,,,,,fee schedule,Payment capped at billed charges,293,,,,,,,fee schedule,,586,,,,,,,fee schedule,Payment capped at billed charges,209.3,,,,,,,fee schedule,Payment capped at billed charges,374.4,,,,,,,fee schedule,Payment capped at billed charges,203.21,,,,,,,fee schedule,Payment capped at billed charges,336.96,,,,,,,fee schedule,Payment capped at billed charges,488.6865386,,,,,,,fee schedule,Payment capped at billed charges,209.3,,,,,,,fee schedule,Payment capped at billed charges,164.99,,,,,,,fee schedule,,380.9,,,,,,,percent of total billed charges,
SP EVAL AUD REHAB STATUS 1STHR,96001037,CDM,0440,RC,92626,CPT,11,Local,GN  ,outpatient,professional,,,444,150,70.91,377.4,cash pricing is a case rate for all services provided during a visit,87.64,,,,,,,fee schedule,,87.96,,,,,,,fee schedule,,247.24,,,,,,,fee schedule,Payment capped at billed charges,70.91,,,,,,,fee schedule,,220.04,,,,,,,fee schedule,Payment capped at billed charges,182.96,,,,,,,fee schedule,Payment capped at billed charges,85,,,,,,,fee schedule,payment capped at 80% of billed charges,377.4,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,115.73,,,,,,,fee schedule,Payment capped at billed charges,96.43,,,,,,,fee schedule,Payment capped at billed charges,80.74,,,,,,,fee schedule,Payment capped at billed charges,87.64,,,,,,,fee schedule,Payment capped at billed charges,98,,,,,,,fee schedule,Payment capped at billed charges,78.39,,,,,,,fee schedule,,253.13,,,,,,,fee schedule,Payment capped at billed charges,88.82,,,,,,,fee schedule,Payment capped at billed charges,203.6,,,,,,,fee schedule,Payment capped at billed charges,86.24,,,,,,,fee schedule,Payment capped at billed charges,183.25,,,,,,,fee schedule,Payment capped at billed charges,211.3980182,,,,,,,fee schedule,Payment capped at billed charges,88.82,,,,,,,fee schedule,Payment capped at billed charges,77.23,,,,,,,fee schedule,,288.6,,,,,,,percent of total billed charges,
SP EVAL AUD REHAB STAT ADD 15M,96001045,CDM,0440,RC,92627,CPT,11,Local,GN  ,outpatient,professional,,,110,150,17.54,93.5,cash pricing is a case rate for all services provided during a visit,20.73,,,,,,,fee schedule,,20.81,,,,,,,fee schedule,,58.46,,,,,,,fee schedule,Payment capped at billed charges,17.54,,,,,,,fee schedule,,52.03,,,,,,,fee schedule,Payment capped at billed charges,43.26,,,,,,,fee schedule,Payment capped at billed charges,20.1,,,,,,,fee schedule,payment capped at 80% of billed charges,93.5,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,27.37,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,19.98,,,,,,,fee schedule,Payment capped at billed charges,20.73,,,,,,,fee schedule,Payment capped at billed charges,23.17,,,,,,,fee schedule,Payment capped at billed charges,18.54,,,,,,,fee schedule,,59.35,,,,,,,fee schedule,Payment capped at billed charges,21.01,,,,,,,fee schedule,Payment capped at billed charges,51.48,,,,,,,fee schedule,Payment capped at billed charges,20.4,,,,,,,fee schedule,Payment capped at billed charges,46.32,,,,,,,fee schedule,Payment capped at billed charges,49.79743017,,,,,,,fee schedule,Payment capped at billed charges,21.01,,,,,,,fee schedule,Payment capped at billed charges,19.11,,,,,,,fee schedule,,71.5,,,,,,,percent of total billed charges,
SP EVAL APHASIA 60 MIN,96001052,CDM,0444,RC,96105,CPT,11,Local,GN  ,outpatient,professional,,,281,150,84.42,278.57,cash pricing is a case rate for all services provided during a visit,98.29,,,,,,,fee schedule,,98.65,,,,,,,fee schedule,,273.76,,,,,,,fee schedule,Payment capped at billed charges,84.42,,,,,,,fee schedule,,243.65,,,,,,,fee schedule,Payment capped at billed charges,202.58,,,,,,,fee schedule,Payment capped at billed charges,95.33,,,,,,,fee schedule,payment capped at 80% of billed charges,238.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,129.12,,,,,,,fee schedule,Payment capped at billed charges,107.59,,,,,,,fee schedule,Payment capped at billed charges,96.12,,,,,,,fee schedule,Payment capped at billed charges,98.29,,,,,,,fee schedule,Payment capped at billed charges,109.34,,,,,,,fee schedule,Payment capped at billed charges,87.47,,,,,,,fee schedule,,278.57,,,,,,,fee schedule,Payment capped at billed charges,99.62,,,,,,,fee schedule,Payment capped at billed charges,201.7,,,,,,,fee schedule,Payment capped at billed charges,96.72,,,,,,,fee schedule,Payment capped at billed charges,195.07,,,,,,,fee schedule,Payment capped at billed charges,236.7680365,,,,,,,fee schedule,Payment capped at billed charges,99.62,,,,,,,fee schedule,Payment capped at billed charges,91.94,,,,,,,fee schedule,,182.65,,,,,,,percent of total billed charges,
SP DEVEL TEST ADMIN 1ST HR,96001060,CDM,0440,RC,96112,CPT,11,Local,GN  ,outpatient,professional,,,378,150,90,354.81,cash pricing is a case rate for all services provided during a visit,133.43,,,,,,,fee schedule,,133.92,,,,,,,fee schedule,,350.03,,,,,,,fee schedule,Payment capped at billed charges,116.84,,,,,,,fee schedule,,311.53,,,,,,,fee schedule,Payment capped at billed charges,259.02,,,,,,,fee schedule,Payment capped at billed charges,129.43,,,,,,,fee schedule,payment capped at 80% of billed charges,321.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,173.89,,,,,,,fee schedule,Payment capped at billed charges,144.89,,,,,,,fee schedule,Payment capped at billed charges,133.03,,,,,,,fee schedule,Payment capped at billed charges,133.43,,,,,,,fee schedule,Payment capped at billed charges,147.24,,,,,,,fee schedule,Payment capped at billed charges,117.79,,,,,,,fee schedule,,354.81,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,261.71,,,,,,,fee schedule,Payment capped at billed charges,131.3,,,,,,,fee schedule,Payment capped at billed charges,235.55,,,,,,,fee schedule,Payment capped at billed charges,304.0647219,,,,,,,fee schedule,Payment capped at billed charges,135.23,,,,,,,fee schedule,Payment capped at billed charges,127.25,,,,,,,fee schedule,,245.7,,,,,,,percent of total billed charges,
SP DEVEL TEST ADMIN EA ADD 30M,96001078,CDM,0440,RC,96113,CPT,11,Local,GN  ,outpatient,professional,,,169,150,49.16,169,cash pricing is a case rate for all services provided during a visit,55.66,,,,,,,fee schedule,,55.86,,,,,,,fee schedule,,169,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,151.55,,,,,,,fee schedule,Payment capped at billed charges,126.01,,,,,,,fee schedule,Payment capped at billed charges,53.99,,,,,,,fee schedule,payment capped at 80% of billed charges,143.65,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,72.56,,,,,,,fee schedule,Payment capped at billed charges,60.46,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,55.66,,,,,,,fee schedule,Payment capped at billed charges,61.45,,,,,,,fee schedule,Payment capped at billed charges,49.16,,,,,,,fee schedule,,168.24,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,123.18,,,,,,,fee schedule,Payment capped at billed charges,54.77,,,,,,,fee schedule,Payment capped at billed charges,110.86,,,,,,,fee schedule,Payment capped at billed charges,144.044931,,,,,,,fee schedule,Payment capped at billed charges,56.41,,,,,,,fee schedule,Payment capped at billed charges,55.66,,,,,,,fee schedule,,109.85,,,,,,,percent of total billed charges,
SP COGNITIVE PERF TEST PER HR,96001086,CDM,0444,RC,96125,CPT,11,Local,GN  ,outpatient,professional,,,305,150,90,297.27,cash pricing is a case rate for all services provided during a visit,104.58,,,,,,,fee schedule,,104.96,,,,,,,fee schedule,,293.78,,,,,,,fee schedule,Payment capped at billed charges,90.19,,,,,,,fee schedule,,261.46,,,,,,,fee schedule,Payment capped at billed charges,217.4,,,,,,,fee schedule,Payment capped at billed charges,101.45,,,,,,,fee schedule,payment capped at 80% of billed charges,259.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,138,,,,,,,fee schedule,Payment capped at billed charges,114.98,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,104.58,,,,,,,fee schedule,Payment capped at billed charges,116.85,,,,,,,fee schedule,Payment capped at billed charges,152.5,,,,,,,fee schedule,,297.27,,,,,,,fee schedule,Payment capped at billed charges,105.99,,,,,,,fee schedule,Payment capped at billed charges,251.15,,,,,,,fee schedule,Payment capped at billed charges,102.91,,,,,,,fee schedule,Payment capped at billed charges,226.03,,,,,,,fee schedule,Payment capped at billed charges,248.9168417,,,,,,,fee schedule,Payment capped at billed charges,105.99,,,,,,,fee schedule,Payment capped at billed charges,104.58,,,,,,,fee schedule,,198.25,,,,,,,percent of total billed charges,
SP THERAPUTIC EXERCISE 15MIN,96001094,CDM,0440,RC,97110,CPT,11,Local,GN  ,outpatient,professional,,,80,150,27.16,90,cash pricing is a case rate for all services provided during a visit,30.26,,,,,,,fee schedule,,30.37,,,,,,,fee schedule,,72.98,,,,,,,fee schedule,Payment capped at billed charges,29.61,,,,,,,fee schedule,,64.95,,,,,,,fee schedule,Payment capped at billed charges,54.01,,,,,,,fee schedule,Payment capped at billed charges,29.36,,,,,,,fee schedule,payment capped at 80% of billed charges,68,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,40.1,,,,,,,fee schedule,Payment capped at billed charges,33.41,,,,,,,fee schedule,Payment capped at billed charges,33.38,,,,,,,fee schedule,Payment capped at billed charges,30.26,,,,,,,fee schedule,Payment capped at billed charges,33.96,,,,,,,fee schedule,Payment capped at billed charges,27.16,,,,,,,fee schedule,,69.34,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,42.31,,,,,,,fee schedule,Payment capped at billed charges,29.78,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,71.88918715,,,,,,,fee schedule,Payment capped at billed charges,30.67,,,,,,,fee schedule,Payment capped at billed charges,31.93,,,,,,,fee schedule,,52,,,,,,,percent of total billed charges,
SP COGNITIVE FUNC INTRV 1ST15M,96001102,CDM,0440,RC,97129,CPT,11,Local,GN  ,outpatient,professional,,,72,150,20.71,90,cash pricing is a case rate for all services provided during a visit,22.5,,,,,,,fee schedule,,22.58,,,,,,,fee schedule,,53.99,,,,,,,fee schedule,Payment capped at billed charges,20.71,,,,,,,fee schedule,,48.05,,,,,,,fee schedule,Payment capped at billed charges,39.95,,,,,,,fee schedule,Payment capped at billed charges,21.82,,,,,,,fee schedule,payment capped at 80% of billed charges,61.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.31,,,,,,,fee schedule,Payment capped at billed charges,24.42,,,,,,,fee schedule,Payment capped at billed charges,23.58,,,,,,,fee schedule,Payment capped at billed charges,22.5,,,,,,,fee schedule,Payment capped at billed charges,24.82,,,,,,,fee schedule,Payment capped at billed charges,36,,,,,,,fee schedule,,51.47,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,41.21,,,,,,,fee schedule,Payment capped at billed charges,22.14,,,,,,,fee schedule,Payment capped at billed charges,37.09,,,,,,,fee schedule,Payment capped at billed charges,54.00902627,,,,,,,fee schedule,Payment capped at billed charges,22.8,,,,,,,fee schedule,Payment capped at billed charges,22.55,,,,,,,fee schedule,,46.8,,,,,,,percent of total billed charges,
SP COGNITIVE FUNC INTRV ADD15M,96001110,CDM,0440,RC,97130,CPT,11,Local,GN  ,outpatient,professional,,,72,150,19.79,90,cash pricing is a case rate for all services provided during a visit,21.49,,,,,,,fee schedule,,21.57,,,,,,,fee schedule,,51.55,,,,,,,fee schedule,Payment capped at billed charges,19.79,,,,,,,fee schedule,,45.88,,,,,,,fee schedule,Payment capped at billed charges,38.15,,,,,,,fee schedule,Payment capped at billed charges,20.85,,,,,,,fee schedule,payment capped at 80% of billed charges,61.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,27.99,,,,,,,fee schedule,Payment capped at billed charges,23.32,,,,,,,fee schedule,Payment capped at billed charges,22.53,,,,,,,fee schedule,Payment capped at billed charges,21.49,,,,,,,fee schedule,Payment capped at billed charges,23.7,,,,,,,fee schedule,Payment capped at billed charges,36,,,,,,,fee schedule,,50,,,,,,,fee schedule,Payment capped at billed charges,21.78,,,,,,,fee schedule,Payment capped at billed charges,39.37,,,,,,,fee schedule,Payment capped at billed charges,21.15,,,,,,,fee schedule,Payment capped at billed charges,35.43,,,,,,,fee schedule,Payment capped at billed charges,51.58683699,,,,,,,fee schedule,Payment capped at billed charges,21.78,,,,,,,fee schedule,Payment capped at billed charges,21.55,,,,,,,fee schedule,,46.8,,,,,,,percent of total billed charges,
SP OTHER THERA PROC 1 -15MIN,96001128,CDM,0440,RC,97139,CPT,11,Local,GN  ,outpatient,professional,,,65,150,13.08,90,cash pricing is a case rate for all services provided during a visit,65,,,,,,,fee schedule,,22.75,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,13.51,,,,,,,fee schedule,,,,,,,,,,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,52,,,,,,,fee schedule,payment capped at 80% of billed charges,55.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,15.39,,,,,,,fee schedule,Payment capped at billed charges,42.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,32.5,,,,,,,fee schedule,,42.85,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,31.6536,,,,,,,fee schedule,Payment capped at billed charges,13.2,,,,,,,fee schedule,Payment capped at billed charges,14.72,,,,,,,fee schedule,,42.25,,,,,,,percent of total billed charges,
SP THER ACT EA 15 MIN,96001136,CDM,0440,RC,97530,CPT,11,Local,GN  ,outpatient,professional,,,102,150,31.17,92.44,cash pricing is a case rate for all services provided during a visit,36.56,,,,,,,fee schedule,,36.69,,,,,,,fee schedule,,92.44,,,,,,,fee schedule,Payment capped at billed charges,31.17,,,,,,,fee schedule,,82.27,,,,,,,fee schedule,Payment capped at billed charges,68.41,,,,,,,fee schedule,Payment capped at billed charges,35.46,,,,,,,fee schedule,payment capped at 80% of billed charges,86.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,48.77,,,,,,,fee schedule,Payment capped at billed charges,40.64,,,,,,,fee schedule,Payment capped at billed charges,35.14,,,,,,,fee schedule,Payment capped at billed charges,36.56,,,,,,,fee schedule,Payment capped at billed charges,41.3,,,,,,,fee schedule,Payment capped at billed charges,33.03,,,,,,,fee schedule,,89.29,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,42.5,,,,,,,fee schedule,Payment capped at billed charges,35.98,,,,,,,fee schedule,Payment capped at billed charges,37.27,,,,,,,fee schedule,Payment capped at billed charges,91.25433935,,,,,,,fee schedule,Payment capped at billed charges,37.05,,,,,,,fee schedule,Payment capped at billed charges,33.62,,,,,,,fee schedule,,66.3,,,,,,,percent of total billed charges,
AFO MOLDED TP PATIENT PLASTI,96001151,CDM,0274,RC,L1940,HCPCS,11,Local,NU  ,outpatient,professional,,,571,150,90,571,cash pricing is a case rate for all services provided during a visit,571,,,,,,,fee schedule,,199.85,,,,,,,fee schedule,,571,,,,,,,fee schedule,Payment capped at billed charges,194.14,,,,,,,fee schedule,,520.36,,,,,,,fee schedule,Payment capped at billed charges,432.66,,,,,,,fee schedule,Payment capped at billed charges,456.8,,,,,,,fee schedule,payment capped at 80% of billed charges,485.35,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,371.15,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,468.01,,,,,,,fee schedule,,371.15,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,299,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,299,,,,,,,fee schedule,Payment capped at billed charges,551.8326,,,,,,,fee schedule,Payment capped at billed charges,230.17,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,371.15,,,,,,,percent of total billed charges,
AFO TIB FX CAST MOLDED TO PT,96001169,CDM,0274,RC,L2108,HCPCS,11,Local,NU  ,outpatient,professional,,,1234,150,90,1321.0054,cash pricing is a case rate for all services provided during a visit,1234,,,,,,,fee schedule,,431.9,,,,,,,fee schedule,,1234,,,,,,,fee schedule,Payment capped at billed charges,419.56,,,,,,,fee schedule,,1234,,,,,,,fee schedule,Payment capped at billed charges,1035.69,,,,,,,fee schedule,Payment capped at billed charges,987.2,,,,,,,fee schedule,payment capped at 80% of billed charges,1048.9,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,802.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1120.33,,,,,,,fee schedule,,802.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,715,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,715,,,,,,,fee schedule,Payment capped at billed charges,1321.0054,,,,,,,fee schedule,Payment capped at billed charges,551,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,802.1,,,,,,,percent of total billed charges,
KAFO FEM FX CAST MOLDED TO PT,96001177,CDM,0274,RC,L2128,HCPCS,11,Local,NU  ,outpatient,professional,,,1981,150,90,2077.1102,cash pricing is a case rate for all services provided during a visit,1981,,,,,,,fee schedule,,693.35,,,,,,,fee schedule,,1981,,,,,,,fee schedule,Payment capped at billed charges,673.54,,,,,,,fee schedule,,1958.6,,,,,,,fee schedule,Payment capped at billed charges,1628.5,,,,,,,fee schedule,Payment capped at billed charges,1584.8,,,,,,,fee schedule,payment capped at 80% of billed charges,1683.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,1287.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,990.5,,,,,,,fee schedule,,1287.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1124,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1124,,,,,,,fee schedule,Payment capped at billed charges,2077.1102,,,,,,,fee schedule,Payment capped at billed charges,866.38,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1287.65,,,,,,,percent of total billed charges,
FOOT LONGITUDE METATARSAL SUP,96001185,CDM,0274,RC,L3020,HCPCS,11,Local,NU  ,outpatient,professional,,,239,150,81.26,239,cash pricing is a case rate for all services provided during a visit,239,,,,,,,fee schedule,,83.65,,,,,,,fee schedule,,239,,,,,,,fee schedule,Payment capped at billed charges,81.26,,,,,,,fee schedule,,217.89,,,,,,,fee schedule,Payment capped at billed charges,181.17,,,,,,,fee schedule,Payment capped at billed charges,191.2,,,,,,,fee schedule,payment capped at 80% of billed charges,203.15,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,155.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,195.97,,,,,,,fee schedule,,155.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,130.26,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,130.26,,,,,,,fee schedule,Payment capped at billed charges,231.0858,,,,,,,fee schedule,Payment capped at billed charges,96.39,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,155.35,,,,,,,percent of total billed charges,
SO CAP DESIGN W/O JNTS CF,96001193,CDM,0274,RC,L3671,HCPCS,11,Local,NU  ,outpatient,professional,,,905,150,90,955.1982,cash pricing is a case rate for all services provided during a visit,905,,,,,,,fee schedule,,316.75,,,,,,,fee schedule,,905,,,,,,,fee schedule,Payment capped at billed charges,307.7,,,,,,,fee schedule,,900.69,,,,,,,fee schedule,Payment capped at billed charges,748.89,,,,,,,fee schedule,Payment capped at billed charges,724,,,,,,,fee schedule,payment capped at 80% of billed charges,769.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,588.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,452.5,,,,,,,fee schedule,,588.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,586.7,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,586.7,,,,,,,fee schedule,Payment capped at billed charges,955.1982,,,,,,,fee schedule,Payment capped at billed charges,398.42,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,588.25,,,,,,,percent of total billed charges,
SO AIRPLANE W/WO JOINT CF,96001201,CDM,0274,RC,L3674,HCPCS,11,Local,NU  ,outpatient,professional,,,1187,150,90,1253.0034,cash pricing is a case rate for all services provided during a visit,1187,,,,,,,fee schedule,,415.45,,,,,,,fee schedule,,1187,,,,,,,fee schedule,Payment capped at billed charges,403.58,,,,,,,fee schedule,,1181.5,,,,,,,fee schedule,Payment capped at billed charges,982.37,,,,,,,fee schedule,Payment capped at billed charges,949.6,,,,,,,fee schedule,payment capped at 80% of billed charges,1008.95,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,771.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,593.5,,,,,,,fee schedule,,771.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,797.81,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,797.81,,,,,,,fee schedule,Payment capped at billed charges,1253.0034,,,,,,,fee schedule,Payment capped at billed charges,522.64,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,771.55,,,,,,,percent of total billed charges,
EO ELBOW STATIC CUST FIT ADJ,96001219,CDM,0274,RC,L3702,HCPCS,11,Local,NU  ,outpatient,professional,,,328,150,90,328,cash pricing is a case rate for all services provided during a visit,328,,,,,,,fee schedule,,114.8,,,,,,,fee schedule,,324.29,,,,,,,fee schedule,Payment capped at billed charges,111.52,,,,,,,fee schedule,,288.62,,,,,,,fee schedule,Payment capped at billed charges,239.97,,,,,,,fee schedule,Payment capped at billed charges,262.4,,,,,,,fee schedule,payment capped at 80% of billed charges,278.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,213.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,164,,,,,,,fee schedule,,213.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,188,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,188,,,,,,,fee schedule,Payment capped at billed charges,306.0816,,,,,,,fee schedule,Payment capped at billed charges,127.67,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,213.2,,,,,,,percent of total billed charges,
EO ELB STAT PROG DBL HING CUST,96001227,CDM,0274,RC,L3730,HCPCS,11,Local,NU  ,outpatient,professional,,,1019,150,90,1019,cash pricing is a case rate for all services provided during a visit,1019,,,,,,,fee schedule,,356.65,,,,,,,fee schedule,,1019,,,,,,,fee schedule,Payment capped at billed charges,346.46,,,,,,,fee schedule,,928.14,,,,,,,fee schedule,Payment capped at billed charges,771.71,,,,,,,fee schedule,Payment capped at billed charges,815.2,,,,,,,fee schedule,payment capped at 80% of billed charges,866.15,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,662.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,509.5,,,,,,,fee schedule,,662.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,533,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,533,,,,,,,fee schedule,Payment capped at billed charges,984.2866,,,,,,,fee schedule,Payment capped at billed charges,410.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,662.35,,,,,,,percent of total billed charges,
EO STAT CUSTOM F A,96001235,CDM,0274,RC,L3740,HCPCS,11,Local,NU  ,outpatient,professional,,,1208,150,90,1208,cash pricing is a case rate for all services provided during a visit,1208,,,,,,,fee schedule,,422.8,,,,,,,fee schedule,,1208,,,,,,,fee schedule,Payment capped at billed charges,410.72,,,,,,,fee schedule,,1100.39,,,,,,,fee schedule,Payment capped at billed charges,914.93,,,,,,,fee schedule,Payment capped at billed charges,966.4,,,,,,,fee schedule,payment capped at 80% of billed charges,1026.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,785.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,604,,,,,,,fee schedule,,785.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,632,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,632,,,,,,,fee schedule,Payment capped at billed charges,1166.9724,,,,,,,fee schedule,Payment capped at billed charges,486.75,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,785.2,,,,,,,percent of total billed charges,
EWHO ELB WRIST HD STAT CUSTFIT,96001243,CDM,0274,RC,L3763,HCPCS,11,Local,NU  ,outpatient,professional,,,739,150,90,744.0774,cash pricing is a case rate for all services provided during a visit,739,,,,,,,fee schedule,,258.65,,,,,,,fee schedule,,739,,,,,,,fee schedule,Payment capped at billed charges,251.26,,,,,,,fee schedule,,701.62,,,,,,,fee schedule,Payment capped at billed charges,583.37,,,,,,,fee schedule,Payment capped at billed charges,591.2,,,,,,,fee schedule,payment capped at 80% of billed charges,628.15,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,480.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,369.5,,,,,,,fee schedule,,480.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,457.04,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,457.04,,,,,,,fee schedule,Payment capped at billed charges,744.0774,,,,,,,fee schedule,Payment capped at billed charges,310.36,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,480.35,,,,,,,percent of total billed charges,
EWHO W/JOINT(S) CF,96001250,CDM,0274,RC,L3764,HCPCS,11,Local,NU  ,outpatient,professional,,,841,150,90,971.1944,cash pricing is a case rate for all services provided during a visit,841,,,,,,,fee schedule,,294.35,,,,,,,fee schedule,,841,,,,,,,fee schedule,Payment capped at billed charges,285.94,,,,,,,fee schedule,,841,,,,,,,fee schedule,Payment capped at billed charges,761.45,,,,,,,fee schedule,Payment capped at billed charges,672.8,,,,,,,fee schedule,payment capped at 80% of billed charges,714.85,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,546.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,420.5,,,,,,,fee schedule,,546.65,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,596.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,596.55,,,,,,,fee schedule,Payment capped at billed charges,971.1944,,,,,,,fee schedule,Payment capped at billed charges,405.09,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,546.65,,,,,,,percent of total billed charges,
EWHFO STATIC CUSTOM FIT   ADJ,96001268,CDM,0274,RC,L3765,HCPCS,11,Local,NU  ,outpatient,professional,,,1288,150,90,1359.2172,cash pricing is a case rate for all services provided during a visit,1288,,,,,,,fee schedule,,450.8,,,,,,,fee schedule,,1288,,,,,,,fee schedule,Payment capped at billed charges,437.92,,,,,,,fee schedule,,1281.66,,,,,,,fee schedule,Payment capped at billed charges,1065.65,,,,,,,fee schedule,Payment capped at billed charges,1030.4,,,,,,,fee schedule,payment capped at 80% of billed charges,1094.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,837.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,644,,,,,,,fee schedule,,837.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,876.61,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,876.61,,,,,,,fee schedule,Payment capped at billed charges,1359.2172,,,,,,,fee schedule,Payment capped at billed charges,566.94,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,837.2,,,,,,,percent of total billed charges,
EWHFO W/JOINT(S) CF,96001276,CDM,0274,RC,L3766,HCPCS,11,Local,NU  ,outpatient,professional,,,1363,150,90,1439.3192,cash pricing is a case rate for all services provided during a visit,1363,,,,,,,fee schedule,,477.05,,,,,,,fee schedule,,1363,,,,,,,fee schedule,Payment capped at billed charges,463.42,,,,,,,fee schedule,,1357.19,,,,,,,fee schedule,Payment capped at billed charges,1128.45,,,,,,,fee schedule,Payment capped at billed charges,1090.4,,,,,,,fee schedule,payment capped at 80% of billed charges,1158.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,885.95,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,681.5,,,,,,,fee schedule,,885.95,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,928.26,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,928.26,,,,,,,fee schedule,Payment capped at billed charges,1439.3192,,,,,,,fee schedule,Payment capped at billed charges,600.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,885.95,,,,,,,percent of total billed charges,
WHFO STAT PROG DYN CUSTOM FIT,96001284,CDM,0274,RC,L3806,HCPCS,11,Local,NU  ,outpatient,professional,,,518,150,90,518,cash pricing is a case rate for all services provided during a visit,518,,,,,,,fee schedule,,181.3,,,,,,,fee schedule,,510.18,,,,,,,fee schedule,Payment capped at billed charges,176.12,,,,,,,fee schedule,,454.06,,,,,,,fee schedule,Payment capped at billed charges,377.53,,,,,,,fee schedule,Payment capped at billed charges,414.4,,,,,,,fee schedule,payment capped at 80% of billed charges,440.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,336.7,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,408.39,,,,,,,fee schedule,,336.7,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,310.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,310.55,,,,,,,fee schedule,Payment capped at billed charges,481.5316,,,,,,,fee schedule,Payment capped at billed charges,200.85,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,336.7,,,,,,,percent of total billed charges,
WHFO STATIC CUSTOM FIT   ADJ,96001292,CDM,0274,RC,L3808,HCPCS,11,Local,NU  ,outpatient,professional,,,374,150,90,396.396,cash pricing is a case rate for all services provided during a visit,374,,,,,,,fee schedule,,130.9,,,,,,,fee schedule,,374,,,,,,,fee schedule,Payment capped at billed charges,127.16,,,,,,,fee schedule,,373.78,,,,,,,fee schedule,Payment capped at billed charges,310.79,,,,,,,fee schedule,Payment capped at billed charges,299.2,,,,,,,fee schedule,payment capped at 80% of billed charges,317.9,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,243.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,336.19,,,,,,,fee schedule,,243.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,243.47,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,243.47,,,,,,,fee schedule,Payment capped at billed charges,396.396,,,,,,,fee schedule,Payment capped at billed charges,165.34,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,243.1,,,,,,,percent of total billed charges,
TENODESIS SPLINT CUST FIT ADJ,96001300,CDM,0274,RC,L3900,HCPCS,11,Local,NU  ,outpatient,professional,,,1463,150,90,1545.654,cash pricing is a case rate for all services provided during a visit,1463,,,,,,,fee schedule,,512.05,,,,,,,fee schedule,,1463,,,,,,,fee schedule,Payment capped at billed charges,497.42,,,,,,,fee schedule,,1457.46,,,,,,,fee schedule,Payment capped at billed charges,1211.82,,,,,,,fee schedule,Payment capped at billed charges,1170.4,,,,,,,fee schedule,payment capped at 80% of billed charges,1243.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,950.95,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1310.85,,,,,,,fee schedule,,950.95,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,837,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,837,,,,,,,fee schedule,Payment capped at billed charges,1545.654,,,,,,,fee schedule,Payment capped at billed charges,644.7,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,950.95,,,,,,,percent of total billed charges,
WHO STATIC PROG DYN CUSTOM FIT,96001318,CDM,0274,RC,L3905,HCPCS,11,Local,NU  ,outpatient,professional,,,996,150,90,1051.248,cash pricing is a case rate for all services provided during a visit,996,,,,,,,fee schedule,,348.6,,,,,,,fee schedule,,996,,,,,,,fee schedule,Payment capped at billed charges,338.64,,,,,,,fee schedule,,991.27,,,,,,,fee schedule,Payment capped at billed charges,824.2,,,,,,,fee schedule,Payment capped at billed charges,796.8,,,,,,,fee schedule,payment capped at 80% of billed charges,846.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,647.4,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,498,,,,,,,fee schedule,,647.4,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,645.71,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,645.71,,,,,,,fee schedule,Payment capped at billed charges,1051.248,,,,,,,fee schedule,Payment capped at billed charges,438.48,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,647.4,,,,,,,percent of total billed charges,
WHO STATIC CUSTOM FIT   ADJ,96001326,CDM,0274,RC,L3906,HCPCS,11,Local,NU  ,outpatient,professional,,,447,150,90,466.7454,cash pricing is a case rate for all services provided during a visit,447,,,,,,,fee schedule,,156.45,,,,,,,fee schedule,,447,,,,,,,fee schedule,Payment capped at billed charges,151.98,,,,,,,fee schedule,,440.11,,,,,,,fee schedule,Payment capped at billed charges,365.94,,,,,,,fee schedule,Payment capped at billed charges,357.6,,,,,,,fee schedule,payment capped at 80% of billed charges,379.95,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,290.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,395.84,,,,,,,fee schedule,,290.55,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,253,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,253,,,,,,,fee schedule,Payment capped at billed charges,466.7454,,,,,,,fee schedule,Payment capped at billed charges,194.68,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,290.55,,,,,,,percent of total billed charges,
HFO STATIC CUSTOM FIT   ADJ,96001334,CDM,0274,RC,L3913,HCPCS,11,Local,NU  ,outpatient,professional,,,285,150,90,287.1088,cash pricing is a case rate for all services provided during a visit,285,,,,,,,fee schedule,,99.75,,,,,,,fee schedule,,285,,,,,,,fee schedule,Payment capped at billed charges,96.9,,,,,,,fee schedule,,270.72,,,,,,,fee schedule,Payment capped at billed charges,225.09,,,,,,,fee schedule,Payment capped at billed charges,228,,,,,,,fee schedule,payment capped at 80% of billed charges,242.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,185.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,142.5,,,,,,,fee schedule,,185.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,176.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,176.35,,,,,,,fee schedule,Payment capped at billed charges,287.1088,,,,,,,fee schedule,Payment capped at billed charges,119.76,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,185.25,,,,,,,percent of total billed charges,
HO HAND ORTHO STAT CUST FIT,96001342,CDM,0274,RC,L3919,HCPCS,11,Local,NU  ,outpatient,professional,,,272,150,90,287.1088,cash pricing is a case rate for all services provided during a visit,272,,,,,,,fee schedule,,95.2,,,,,,,fee schedule,,272,,,,,,,fee schedule,Payment capped at billed charges,92.48,,,,,,,fee schedule,,270.72,,,,,,,fee schedule,Payment capped at billed charges,225.09,,,,,,,fee schedule,Payment capped at billed charges,217.6,,,,,,,fee schedule,payment capped at 80% of billed charges,231.2,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,176.8,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,136,,,,,,,fee schedule,,176.8,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,176.35,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,176.35,,,,,,,fee schedule,Payment capped at billed charges,287.1088,,,,,,,fee schedule,Payment capped at billed charges,119.76,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,176.8,,,,,,,percent of total billed charges,
HFO STATIC PROG/DYN CUSTOM FIT,96001359,CDM,0274,RC,L3921,HCPCS,11,Local,NU  ,outpatient,professional,,,345,150,90,345,cash pricing is a case rate for all services provided during a visit,345,,,,,,,fee schedule,,120.75,,,,,,,fee schedule,,345,,,,,,,fee schedule,Payment capped at billed charges,117.3,,,,,,,fee schedule,,321.07,,,,,,,fee schedule,Payment capped at billed charges,266.96,,,,,,,fee schedule,Payment capped at billed charges,276,,,,,,,fee schedule,payment capped at 80% of billed charges,293.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,224.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,172.5,,,,,,,fee schedule,,224.25,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,209.15,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,209.15,,,,,,,fee schedule,Payment capped at billed charges,340.494,,,,,,,fee schedule,Payment capped at billed charges,142.02,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,224.25,,,,,,,percent of total billed charges,
FO FINGR STATIC CUST ORTHO FIT,96001367,CDM,0274,RC,L3933,HCPCS,11,Local,NU  ,outpatient,professional,,,214,150,72.76,226.149,cash pricing is a case rate for all services provided during a visit,214,,,,,,,fee schedule,,74.9,,,,,,,fee schedule,,214,,,,,,,fee schedule,Payment capped at billed charges,72.76,,,,,,,fee schedule,,213.24,,,,,,,fee schedule,Payment capped at billed charges,177.3,,,,,,,fee schedule,Payment capped at billed charges,171.2,,,,,,,fee schedule,payment capped at 80% of billed charges,181.9,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,139.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,107,,,,,,,fee schedule,,139.1,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,138.92,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,138.92,,,,,,,fee schedule,Payment capped at billed charges,226.149,,,,,,,fee schedule,Payment capped at billed charges,94.33,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,139.1,,,,,,,percent of total billed charges,
FO STAT PROG/DYN CUST ORTH FIT,96001375,CDM,0274,RC,L3935,HCPCS,11,Local,NU  ,outpatient,professional,,,222,150,75.48,234.1592,cash pricing is a case rate for all services provided during a visit,222,,,,,,,fee schedule,,77.7,,,,,,,fee schedule,,222,,,,,,,fee schedule,Payment capped at billed charges,75.48,,,,,,,fee schedule,,220.8,,,,,,,fee schedule,Payment capped at billed charges,183.59,,,,,,,fee schedule,Payment capped at billed charges,177.6,,,,,,,fee schedule,payment capped at 80% of billed charges,188.7,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,144.3,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,111,,,,,,,fee schedule,,144.3,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,143.84,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,143.84,,,,,,,fee schedule,Payment capped at billed charges,234.1592,,,,,,,fee schedule,Payment capped at billed charges,97.67,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,144.3,,,,,,,percent of total billed charges,
SEWHO CAP DESIGN W/O JNTS CF,96001383,CDM,0274,RC,L3961,HCPCS,11,Local,NU  ,outpatient,professional,,,1688,150,90,1780.9748,cash pricing is a case rate for all services provided during a visit,1688,,,,,,,fee schedule,,590.8,,,,,,,fee schedule,,1688,,,,,,,fee schedule,Payment capped at billed charges,573.92,,,,,,,fee schedule,,1679.36,,,,,,,fee schedule,Payment capped at billed charges,1396.32,,,,,,,fee schedule,Payment capped at billed charges,1350.4,,,,,,,fee schedule,payment capped at 80% of billed charges,1434.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,,,,,,,,,,,,,,,,,,,,,,,,,,,,1097.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,844,,,,,,,fee schedule,,1097.2,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1148.61,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1148.61,,,,,,,fee schedule,Payment capped at billed charges,1780.9748,,,,,,,fee schedule,Payment capped at billed charges,742.86,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,1097.2,,,,,,,percent of total billed charges,
SP LARYNGEAL FUNCTION STUDIES,96001391,CDM,0440,RC,92520,CPT,11,Local,GN  ,outpatient,professional,,,285,150,60.64,259.88,cash pricing is a case rate for all services provided during a visit,93.31,,,,,,,fee schedule,,93.65,,,,,,,fee schedule,,259.88,,,,,,,fee schedule,Payment capped at billed charges,60.64,,,,,,,fee schedule,,231.29,,,,,,,fee schedule,Payment capped at billed charges,192.31,,,,,,,fee schedule,Payment capped at billed charges,90.51,,,,,,,fee schedule,payment capped at 80% of billed charges,242.25,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,125.48,,,,,,,fee schedule,Payment capped at billed charges,104.55,,,,,,,fee schedule,Payment capped at billed charges,69.05,,,,,,,fee schedule,Payment capped at billed charges,93.31,,,,,,,fee schedule,Payment capped at billed charges,106.25,,,,,,,fee schedule,Payment capped at billed charges,85,,,,,,,fee schedule,,245.25,,,,,,,fee schedule,Payment capped at billed charges,94.57,,,,,,,fee schedule,Payment capped at billed charges,120.51,,,,,,,fee schedule,Payment capped at billed charges,91.82,,,,,,,fee schedule,Payment capped at billed charges,108.47,,,,,,,fee schedule,Payment capped at billed charges,210.3626965,,,,,,,fee schedule,Payment capped at billed charges,94.57,,,,,,,fee schedule,Payment capped at billed charges,66.04,,,,,,,fee schedule,,185.25,,,,,,,percent of total billed charges,
PT CAREGIVER TRAING 1ST 30 MIN,96001417,CDM,0420,RC,97550,CPT,11,Local,GP  ,outpatient,professional,,,155,150,46.83,152.56,cash pricing is a case rate for all services provided during a visit,54.49,,,,,,,fee schedule,,54.69,,,,,,,fee schedule,,150.77,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,134.19,,,,,,,fee schedule,Payment capped at billed charges,111.57,,,,,,,fee schedule,Payment capped at billed charges,52.86,,,,,,,fee schedule,payment capped at 80% of billed charges,131.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,71.54,,,,,,,fee schedule,Payment capped at billed charges,59.61,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,54.49,,,,,,,fee schedule,Payment capped at billed charges,60.57,,,,,,,fee schedule,Payment capped at billed charges,48.46,,,,,,,fee schedule,,152.56,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,88.28,,,,,,,fee schedule,Payment capped at billed charges,53.62,,,,,,,fee schedule,Payment capped at billed charges,79.45,,,,,,,fee schedule,Payment capped at billed charges,113.3286,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,100.75,,,,,,,percent of total billed charges,
PT CAREGIVER TRAING EA ADDL 15,96001425,CDM,0420,RC,97551,CPT,11,Local,GP  ,outpatient,professional,,,76,150,23.16,90,cash pricing is a case rate for all services provided during a visit,26.61,,,,,,,fee schedule,,26.71,,,,,,,fee schedule,,74.42,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,66.23,,,,,,,fee schedule,Payment capped at billed charges,55.07,,,,,,,fee schedule,Payment capped at billed charges,25.8,,,,,,,fee schedule,payment capped at 80% of billed charges,64.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,34.83,,,,,,,fee schedule,Payment capped at billed charges,29.02,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,26.61,,,,,,,fee schedule,Payment capped at billed charges,29.49,,,,,,,fee schedule,Payment capped at billed charges,23.59,,,,,,,fee schedule,,75.11,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,43.57,,,,,,,fee schedule,Payment capped at billed charges,26.18,,,,,,,fee schedule,Payment capped at billed charges,39.22,,,,,,,fee schedule,Payment capped at billed charges,56.0472,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,49.4,,,,,,,percent of total billed charges,
PT GROUP CAREGIVER TRAINING,96001433,CDM,0420,RC,97552,CPT,11,Local,GP  ,outpatient,professional,,,68,150,20.03,90,cash pricing is a case rate for all services provided during a visit,23.35,,,,,,,fee schedule,,23.44,,,,,,,fee schedule,,65.74,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,58.51,,,,,,,fee schedule,Payment capped at billed charges,48.65,,,,,,,fee schedule,Payment capped at billed charges,22.66,,,,,,,fee schedule,payment capped at 80% of billed charges,57.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,31.26,,,,,,,fee schedule,Payment capped at billed charges,26.05,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.35,,,,,,,fee schedule,Payment capped at billed charges,26.47,,,,,,,fee schedule,Payment capped at billed charges,21.18,,,,,,,fee schedule,,67.25,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,38.49,,,,,,,fee schedule,Payment capped at billed charges,22.98,,,,,,,fee schedule,Payment capped at billed charges,34.64,,,,,,,fee schedule,Payment capped at billed charges,48.4726,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,44.2,,,,,,,percent of total billed charges,
OT CAREGIVER TRAING 1ST 30 MIN,96001441,CDM,0430,RC,97550,CPT,11,Local,GO  ,outpatient,professional,,,155,150,46.83,152.56,cash pricing is a case rate for all services provided during a visit,54.49,,,,,,,fee schedule,,54.69,,,,,,,fee schedule,,150.77,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,134.19,,,,,,,fee schedule,Payment capped at billed charges,111.57,,,,,,,fee schedule,Payment capped at billed charges,52.86,,,,,,,fee schedule,payment capped at 80% of billed charges,131.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,71.54,,,,,,,fee schedule,Payment capped at billed charges,59.61,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,70.84,,,,,,,fee schedule,Payment capped at billed charges,60.57,,,,,,,fee schedule,Payment capped at billed charges,48.46,,,,,,,fee schedule,,152.56,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,88.28,,,,,,,fee schedule,Payment capped at billed charges,53.62,,,,,,,fee schedule,Payment capped at billed charges,79.45,,,,,,,fee schedule,Payment capped at billed charges,113.3286,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,100.75,,,,,,,percent of total billed charges,
OT CAREGIVER TRAING EA ADDL 15,96001458,CDM,0430,RC,97551,CPT,11,Local,GO  ,outpatient,professional,,,76,150,23.16,90,cash pricing is a case rate for all services provided during a visit,26.61,,,,,,,fee schedule,,26.71,,,,,,,fee schedule,,74.42,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,66.23,,,,,,,fee schedule,Payment capped at billed charges,55.07,,,,,,,fee schedule,Payment capped at billed charges,25.8,,,,,,,fee schedule,payment capped at 80% of billed charges,64.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,34.83,,,,,,,fee schedule,Payment capped at billed charges,29.02,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,34.59,,,,,,,fee schedule,Payment capped at billed charges,29.49,,,,,,,fee schedule,Payment capped at billed charges,23.59,,,,,,,fee schedule,,75.11,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,43.57,,,,,,,fee schedule,Payment capped at billed charges,26.18,,,,,,,fee schedule,Payment capped at billed charges,39.22,,,,,,,fee schedule,Payment capped at billed charges,56.0472,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,49.4,,,,,,,percent of total billed charges,
OT GROUP CAREGIVER TRAINING,96001466,CDM,0430,RC,97552,CPT,11,Local,GO  ,outpatient,professional,,,68,150,20.03,90,cash pricing is a case rate for all services provided during a visit,23.35,,,,,,,fee schedule,,23.44,,,,,,,fee schedule,,65.74,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,58.51,,,,,,,fee schedule,Payment capped at billed charges,48.65,,,,,,,fee schedule,Payment capped at billed charges,22.66,,,,,,,fee schedule,payment capped at 80% of billed charges,57.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,31.26,,,,,,,fee schedule,Payment capped at billed charges,26.05,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,30.36,,,,,,,fee schedule,Payment capped at billed charges,26.47,,,,,,,fee schedule,Payment capped at billed charges,21.18,,,,,,,fee schedule,,67.25,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,38.49,,,,,,,fee schedule,Payment capped at billed charges,22.98,,,,,,,fee schedule,Payment capped at billed charges,34.64,,,,,,,fee schedule,Payment capped at billed charges,48.4726,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,44.2,,,,,,,percent of total billed charges,
SP CAREGIVER TRAING 1ST 30 MIN,96001474,CDM,0440,RC,97550,CPT,11,Local,GN  ,outpatient,professional,,,155,150,46.83,152.56,cash pricing is a case rate for all services provided during a visit,54.49,,,,,,,fee schedule,,54.69,,,,,,,fee schedule,,150.77,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,134.19,,,,,,,fee schedule,Payment capped at billed charges,111.57,,,,,,,fee schedule,Payment capped at billed charges,52.86,,,,,,,fee schedule,payment capped at 80% of billed charges,131.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,71.54,,,,,,,fee schedule,Payment capped at billed charges,59.61,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,54.49,,,,,,,fee schedule,Payment capped at billed charges,60.57,,,,,,,fee schedule,Payment capped at billed charges,48.46,,,,,,,fee schedule,,152.56,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,88.28,,,,,,,fee schedule,Payment capped at billed charges,53.62,,,,,,,fee schedule,Payment capped at billed charges,79.45,,,,,,,fee schedule,Payment capped at billed charges,113.3286,,,,,,,fee schedule,Payment capped at billed charges,55.23,,,,,,,fee schedule,Payment capped at billed charges,54.49,,,,,,,fee schedule,,100.75,,,,,,,percent of total billed charges,
SP CAREGIVER TRAING EA ADDL 15,96001482,CDM,0440,RC,97551,CPT,11,Local,GN  ,outpatient,professional,,,76,150,23.16,90,cash pricing is a case rate for all services provided during a visit,26.61,,,,,,,fee schedule,,26.71,,,,,,,fee schedule,,74.42,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,66.23,,,,,,,fee schedule,Payment capped at billed charges,55.07,,,,,,,fee schedule,Payment capped at billed charges,25.8,,,,,,,fee schedule,payment capped at 80% of billed charges,64.6,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,34.83,,,,,,,fee schedule,Payment capped at billed charges,29.02,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,26.61,,,,,,,fee schedule,Payment capped at billed charges,29.49,,,,,,,fee schedule,Payment capped at billed charges,23.59,,,,,,,fee schedule,,75.11,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,43.57,,,,,,,fee schedule,Payment capped at billed charges,26.18,,,,,,,fee schedule,Payment capped at billed charges,39.22,,,,,,,fee schedule,Payment capped at billed charges,56.0472,,,,,,,fee schedule,Payment capped at billed charges,26.97,,,,,,,fee schedule,Payment capped at billed charges,26.61,,,,,,,fee schedule,,49.4,,,,,,,percent of total billed charges,
SP GROUP CAREGIVER TRAINING,96001490,CDM,0440,RC,97552,CPT,11,Local,GN  ,outpatient,professional,,,68,150,20.03,90,cash pricing is a case rate for all services provided during a visit,23.35,,,,,,,fee schedule,,23.44,,,,,,,fee schedule,,65.74,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,58.51,,,,,,,fee schedule,Payment capped at billed charges,48.65,,,,,,,fee schedule,Payment capped at billed charges,22.66,,,,,,,fee schedule,payment capped at 80% of billed charges,57.8,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,31.26,,,,,,,fee schedule,Payment capped at billed charges,26.05,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,23.35,,,,,,,fee schedule,Payment capped at billed charges,26.47,,,,,,,fee schedule,Payment capped at billed charges,21.18,,,,,,,fee schedule,,67.25,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,38.49,,,,,,,fee schedule,Payment capped at billed charges,22.98,,,,,,,fee schedule,Payment capped at billed charges,34.64,,,,,,,fee schedule,Payment capped at billed charges,48.4726,,,,,,,fee schedule,Payment capped at billed charges,23.67,,,,,,,fee schedule,Payment capped at billed charges,23.35,,,,,,,fee schedule,,44.2,,,,,,,percent of total billed charges,
PT RTM INITIAL SETUP,96001508,CDM,0940,RC,98975,CPT,11,Local,GP  ,outpatient,professional,,,258,150,21.08,219.3,cash pricing is a case rate for all services provided during a visit,21.42,,,,,,,fee schedule,,21.5,,,,,,,fee schedule,,51.05,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,45.43,,,,,,,fee schedule,Payment capped at billed charges,37.78,,,,,,,fee schedule,Payment capped at billed charges,206.4,,,,,,,fee schedule,payment capped at 80% of billed charges,219.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.14,,,,,,,fee schedule,Payment capped at billed charges,24.28,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.42,,,,,,,fee schedule,Payment capped at billed charges,24.68,,,,,,,fee schedule,Payment capped at billed charges,129,,,,,,,fee schedule,,59.25,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,43.64,,,,,,,fee schedule,Payment capped at billed charges,21.08,,,,,,,fee schedule,Payment capped at billed charges,39.28,,,,,,,fee schedule,Payment capped at billed charges,48.21740558,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,167.7,,,,,,,percent of total billed charges,
PT RTM DATA COLLECTION,96001516,CDM,0940,RC,98977,CPT,11,Local,GP  ,outpatient,professional,,,75,150,37.5,124.4703966,cash pricing is a case rate for all services provided during a visit,46.45,,,,,,,fee schedule,,46.62,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,60,,,,,,,fee schedule,payment capped at 80% of billed charges,63.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,63.57,,,,,,,fee schedule,Payment capped at billed charges,52.97,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,46.45,,,,,,,fee schedule,Payment capped at billed charges,53.83,,,,,,,fee schedule,Payment capped at billed charges,37.5,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,45.71,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,124.4703966,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,48.75,,,,,,,percent of total billed charges,
PT RTM INITIAL 20 MINS CONSULT,96001524,CDM,0940,RC,98980,CPT,11,Local,GP  ,outpatient,professional,,,106,150,52.33,120.2920235,cash pricing is a case rate for all services provided during a visit,53.18,,,,,,,fee schedule,,53.38,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,91.29,,,,,,,fee schedule,Payment capped at billed charges,84.8,,,,,,,fee schedule,payment capped at 80% of billed charges,90.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,70.7,,,,,,,fee schedule,Payment capped at billed charges,58.91,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,53.18,,,,,,,fee schedule,Payment capped at billed charges,59.87,,,,,,,fee schedule,Payment capped at billed charges,53,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,105.88,,,,,,,fee schedule,Payment capped at billed charges,52.33,,,,,,,fee schedule,Payment capped at billed charges,95.29,,,,,,,fee schedule,Payment capped at billed charges,120.2920235,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,68.9,,,,,,,percent of total billed charges,
PT RTM ADDL 20 MINS CONSULT,96001532,CDM,0940,RC,98981,CPT,11,Local,GP  ,outpatient,professional,,,83,150,40.69,95.98514157,cash pricing is a case rate for all services provided during a visit,41.35,,,,,,,fee schedule,,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,71.2,,,,,,,fee schedule,Payment capped at billed charges,66.4,,,,,,,fee schedule,payment capped at 80% of billed charges,70.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,54.51,,,,,,,fee schedule,Payment capped at billed charges,45.42,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,41.35,,,,,,,fee schedule,Payment capped at billed charges,46.16,,,,,,,fee schedule,Payment capped at billed charges,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,83,,,,,,,fee schedule,Payment capped at billed charges,40.69,,,,,,,fee schedule,Payment capped at billed charges,76.5,,,,,,,fee schedule,Payment capped at billed charges,95.98514157,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,53.95,,,,,,,percent of total billed charges,
OT RTM INITIAL SETUP,96001540,CDM,0940,RC,98975,CPT,11,Local,GO  ,outpatient,professional,,,258,150,21.08,219.3,cash pricing is a case rate for all services provided during a visit,21.42,,,,,,,fee schedule,,21.5,,,,,,,fee schedule,,51.05,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,45.43,,,,,,,fee schedule,Payment capped at billed charges,37.78,,,,,,,fee schedule,Payment capped at billed charges,206.4,,,,,,,fee schedule,payment capped at 80% of billed charges,219.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.14,,,,,,,fee schedule,Payment capped at billed charges,24.28,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,27.85,,,,,,,fee schedule,Payment capped at billed charges,24.68,,,,,,,fee schedule,Payment capped at billed charges,129,,,,,,,fee schedule,,59.25,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,43.64,,,,,,,fee schedule,Payment capped at billed charges,21.08,,,,,,,fee schedule,Payment capped at billed charges,39.28,,,,,,,fee schedule,Payment capped at billed charges,48.21740558,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,167.7,,,,,,,percent of total billed charges,
OT RTM DATA COLLECTION,96001557,CDM,0940,RC,98977,CPT,11,Local,GO  ,outpatient,professional,,,75,150,37.5,124.4703966,cash pricing is a case rate for all services provided during a visit,46.45,,,,,,,fee schedule,,46.62,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,60,,,,,,,fee schedule,payment capped at 80% of billed charges,63.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,63.57,,,,,,,fee schedule,Payment capped at billed charges,52.97,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,60.39,,,,,,,fee schedule,Payment capped at billed charges,53.83,,,,,,,fee schedule,Payment capped at billed charges,37.5,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,45.71,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,124.4703966,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,48.75,,,,,,,percent of total billed charges,
OT RTM INITIAL 20 MINS CONSULT,96001565,CDM,0940,RC,98980,CPT,11,Local,GO  ,outpatient,professional,,,106,150,52.33,120.2920235,cash pricing is a case rate for all services provided during a visit,53.18,,,,,,,fee schedule,,53.38,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,91.29,,,,,,,fee schedule,Payment capped at billed charges,84.8,,,,,,,fee schedule,payment capped at 80% of billed charges,90.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,70.7,,,,,,,fee schedule,Payment capped at billed charges,58.91,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,69.13,,,,,,,fee schedule,Payment capped at billed charges,59.87,,,,,,,fee schedule,Payment capped at billed charges,53,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,105.88,,,,,,,fee schedule,Payment capped at billed charges,52.33,,,,,,,fee schedule,Payment capped at billed charges,95.29,,,,,,,fee schedule,Payment capped at billed charges,120.2920235,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,68.9,,,,,,,percent of total billed charges,
OT RTM ADDL 20 MINS CONSULT,96001573,CDM,0940,RC,98981,CPT,11,Local,GO  ,outpatient,professional,,,83,150,40.69,95.98514157,cash pricing is a case rate for all services provided during a visit,41.35,,,,,,,fee schedule,,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,71.2,,,,,,,fee schedule,Payment capped at billed charges,66.4,,,,,,,fee schedule,payment capped at 80% of billed charges,70.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,54.51,,,,,,,fee schedule,Payment capped at billed charges,45.42,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,53.76,,,,,,,fee schedule,Payment capped at billed charges,46.16,,,,,,,fee schedule,Payment capped at billed charges,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,83,,,,,,,fee schedule,Payment capped at billed charges,40.69,,,,,,,fee schedule,Payment capped at billed charges,76.5,,,,,,,fee schedule,Payment capped at billed charges,95.98514157,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,53.95,,,,,,,percent of total billed charges,
SP RTM INITIAL SETUP,96001581,CDM,0940,RC,98975,CPT,11,Local,GN  ,outpatient,professional,,,258,150,21.08,219.3,cash pricing is a case rate for all services provided during a visit,21.42,,,,,,,fee schedule,,21.5,,,,,,,fee schedule,,51.05,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,45.43,,,,,,,fee schedule,Payment capped at billed charges,37.78,,,,,,,fee schedule,Payment capped at billed charges,206.4,,,,,,,fee schedule,payment capped at 80% of billed charges,219.3,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,29.14,,,,,,,fee schedule,Payment capped at billed charges,24.28,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,21.42,,,,,,,fee schedule,Payment capped at billed charges,24.68,,,,,,,fee schedule,Payment capped at billed charges,129,,,,,,,fee schedule,,59.25,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,43.64,,,,,,,fee schedule,Payment capped at billed charges,21.08,,,,,,,fee schedule,Payment capped at billed charges,39.28,,,,,,,fee schedule,Payment capped at billed charges,48.21740558,,,,,,,fee schedule,Payment capped at billed charges,21.71,,,,,,,fee schedule,Payment capped at billed charges,21.42,,,,,,,fee schedule,,167.7,,,,,,,percent of total billed charges,
SP RTM DATA COLLECTION,96001599,CDM,0940,RC,98977,CPT,11,Local,GN  ,outpatient,professional,,,75,150,37.5,124.4703966,cash pricing is a case rate for all services provided during a visit,46.45,,,,,,,fee schedule,,46.62,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,60,,,,,,,fee schedule,payment capped at 80% of billed charges,63.75,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,63.57,,,,,,,fee schedule,Payment capped at billed charges,52.97,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,46.45,,,,,,,fee schedule,Payment capped at billed charges,53.83,,,,,,,fee schedule,Payment capped at billed charges,37.5,,,,,,,fee schedule,,75,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,45.71,,,,,,,fee schedule,Payment capped at billed charges,75,,,,,,,fee schedule,Payment capped at billed charges,124.4703966,,,,,,,fee schedule,Payment capped at billed charges,47.08,,,,,,,fee schedule,Payment capped at billed charges,46.45,,,,,,,fee schedule,,48.75,,,,,,,percent of total billed charges,
SP RTM INITIAL 20 MINS CONSULT,96001607,CDM,0940,RC,98980,CPT,11,Local,GN  ,outpatient,professional,,,106,150,52.33,120.2920235,cash pricing is a case rate for all services provided during a visit,53.18,,,,,,,fee schedule,,53.38,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,91.29,,,,,,,fee schedule,Payment capped at billed charges,84.8,,,,,,,fee schedule,payment capped at 80% of billed charges,90.1,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,70.7,,,,,,,fee schedule,Payment capped at billed charges,58.91,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,53.18,,,,,,,fee schedule,Payment capped at billed charges,59.87,,,,,,,fee schedule,Payment capped at billed charges,53,,,,,,,fee schedule,,106,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,105.88,,,,,,,fee schedule,Payment capped at billed charges,52.33,,,,,,,fee schedule,Payment capped at billed charges,95.29,,,,,,,fee schedule,Payment capped at billed charges,120.2920235,,,,,,,fee schedule,Payment capped at billed charges,53.9,,,,,,,fee schedule,Payment capped at billed charges,53.18,,,,,,,fee schedule,,68.9,,,,,,,percent of total billed charges,
SP RTM ADDL 20 MINS CONSULT,96001615,CDM,0940,RC,98981,CPT,11,Local,GN  ,outpatient,professional,,,83,150,40.69,95.98514157,cash pricing is a case rate for all services provided during a visit,41.35,,,,,,,fee schedule,,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,71.2,,,,,,,fee schedule,Payment capped at billed charges,66.4,,,,,,,fee schedule,payment capped at 80% of billed charges,70.55,,,,,,,percent of total billed charges,,90,,,,,,,Per Diem,Payment capped at billed charges,54.51,,,,,,,fee schedule,Payment capped at billed charges,45.42,,,,,,,fee schedule,Payment capped at billed charges,,,,,,,,,,41.35,,,,,,,fee schedule,Payment capped at billed charges,46.16,,,,,,,fee schedule,Payment capped at billed charges,41.5,,,,,,,fee schedule,,83,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,83,,,,,,,fee schedule,Payment capped at billed charges,40.69,,,,,,,fee schedule,Payment capped at billed charges,76.5,,,,,,,fee schedule,Payment capped at billed charges,95.98514157,,,,,,,fee schedule,Payment capped at billed charges,41.91,,,,,,,fee schedule,Payment capped at billed charges,41.35,,,,,,,fee schedule,,53.95,,,,,,,percent of total billed charges,
Bilateral Procedure,,,,,,,,,50,outpatient,facility,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,,,150,,,,,,,Reimburses at 150% of the contracted rate,,150,,,,,,,Reimburses at 150% of the contracted rate,,150,,,,,,,Reimburses at 150% of the contracted rate,,,,,,,,,
Reduced Services,,,,,,,,,52,outpatient,facility,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,
Surgical Procedure Only,,,,,,,,,54,outpatient,facility,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,Intra_OP and Pre_OP Columns percentages added together then multiplied by fee scheudule.,,,,,,,,,
Follow-up Care Only,,,,,,,,,55,outpatient,facility,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,Fee Schedule rate * Post Op column percentage from MPFSRVU = base rate,,,,,,,,,
Pre-Op Only,,,,,,,,,56,outpatient,facility,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,Fee Schedule rate * Pre-Op column percentage,,,,,,,,,
Two Surgeons,,,,,,,,,62,outpatient,facility,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,,,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,62.5,,,,,,,Reimburses at 62.50% of the contracted rate (37.50% reduction),,,,,,,,,
Surgical Team,,,,,,,,,66,outpatient,facility,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,,,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,33,,,,,,,Reimburses at 33% of the contracted rate (67% reduction),,,,,,,,,
Discontinued Procedure,,,,,,,,,73,outpatient,facility,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,
Return To OR,,,,,,,,,78,outpatient,facility,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,Intro-Op column percentage * fee schedule rate,,,,,,,,,
Assistant Surgeon,,,,,,,,,80,outpatient,facility,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,
Minimum Assistant Surgeon,,,,,,,,,81,outpatient,facility,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,
Assistant Surgeon (when qualified resident surgeon not available),,,,,,,,,82,outpatient,facility,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,
"Physician Assistant, Nurse Practitioner, Or Clinical nurse Specialist Services For Assistant At Surgery.",,,,,,,,,AS,outpatient,facility,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,,,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,16,,,,,,,Reimburses at 16% of the contracted rate (84% reduction),,,,,,,,,
"Waiver of Liability Statement Issued, as Required by Payer Policy",,,,,,,,,GA,outpatient,facility,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,
"Item or service statutorily excluded, does not meet the definition of any Medicare benefit",,,,,,,,,GY,outpatient,facility,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,Prices to 0 - patient responsibility,,,,,,,,,
Item or service expected to be denied as not reasonable and necessary,,,,,,,,,GZ,outpatient,facility,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,Prices to 0 - non-covered but not patient responsibility.,,,,,,,,,
"Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals",,,,,,,,,QK,outpatient,facility,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,
Medical Direction by Anesthesiologist,,,,,,,,,QX,outpatient,facility,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction,,,,,,,,,
Medical Direction of CRNA,,,,,,,,,QY,outpatient,facility,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,,,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,50,,,,,,,Reimburses at 50% of the contracted rate (50% reduction),,,,,,,,,
Therapy Modifiers for a PTA or an OTA,,,,,,,,,CO|GO,outpatient,facility,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,
Therapy Modifiers for a PTA or an OTA,,,,,,,,,GP|CQ,outpatient,facility,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,,,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,85,,,,,,,Reimburses at 85% of the contracted rate (15% reduction),,,,,,,,,