hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|TX,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Cuero Regional Hospital,12/18/2024,2.0.0,Cuero Regional Hospital,"2550 N Esplanade Street Cuero, TX 77954",74,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,ACCOUNTABLE HP OF AMERICA PLAN,REIMBURSEMENT METHOD,AETNA PLAN,REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,REIMBURSEMENT METHOD,BCBS BLUE ADVANTAGE HMO PLAN,REIMBURSEMENT METHOD,BCBS BLUE ESSENTIALS PLAN,REIMBURSEMENT METHOD,BCBS PPO PLAN,REIMBURSEMENT METHOD,BCBS TRADITIONAL PLAN,REIMBURSEMENT METHOD,BEECH STREET PLAN,REIMBURSEMENT METHOD,CIGNA PLAN,REIMBURSEMENT METHOD,COVENTRY PLAN,REIMBURSEMENT METHOD,GALAXY PLAN,REIMBURSEMENT METHOD,HUMANA EPO PLAN,REIMBURSEMENT METHOD,HUMANA POS PLAN,REIMBURSEMENT METHOD,HUMANA PPO PLAN,REIMBURSEMENT METHOD,MEDICAID PLAN,REIMBURSEMENT METHOD,MEDICARE PLAN,REIMBURSEMENT METHOD,MULTIPLAN PLAN,REIMBURSEMENT METHOD,SUPERIOR PLAN,REIMBURSEMENT METHOD,HUMANA MILITARY TRICARE PLAN,REIMBURSEMENT METHOD,UNICARE PLAN,REIMBURSEMENT METHOD,UNITED HEALTHCARE PLAN,REIMBURSEMENT METHOD,UNITED HEALTHCARE MEDICAID PLAN,REIMBURSEMENT METHOD,AMERIGROUP MEDICARE PLAN,REIMBURSEMENT METHOD,HUMANA MEDICARE PLAN,REIMBURSEMENT METHOD,SCOTT & WHITE MEDICARE PLAN,REIMBURSEMENT METHOD,SUPERIOR ALLWELL HMO PLAN,REIMBURSEMENT METHOD,SUPERIOR ALLWELL PPO PLAN,REIMBURSEMENT METHOD,TX INDEPENDENT HEALTH PLAN,REIMBURSEMENT METHOD,UNITED HEALTHCARE WELLMED,REIMBURSEMENT METHOD,AMERIGROUP MEDICAID PLAN,REIMBURSEMENT METHOD,DRISCOLL CHILDRENS HEALTH PLAN,REIMBURSEMENT METHOD,HUMANA MEDICAID PLAN,REIMBURSEMENT METHOD,MULTIPLAN MEDICAID PLAN,REIMBURSEMENT METHOD,SCOTT & WHITE MEDICAID PLAN,REIMBURSEMENT METHOD,SUPERIOR MEDICAID PLAN,REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE 
Inpatient Medical Services,AMBULATORY,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT MAJOR COMORBID CONDITIONS OR COMPLICATIONS (MCC),360,"$92,999.86 ","$79,049.88 ",85% of total billed charges,"$71,609.89 ",77% of total billed charges,,Not applicable DRG for the associated revenue code,"$76,259.89 ",82% of total billed charges,"$60,489.83 ",85% of total billed charges,"$60,489.83 ",85% of total billed charges,"$60,489.83 ",85% of total billed charges,"$74,399.89 ",90% of total billed charges,"$74,399.89 ",80% of total billed charges,"$83,699.87 ",90% of total billed charges,"$69,749.90 ",75% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,"$62,309.91 ",67% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$74,399.89 ",80% of total billed charges,"$60,449.91 ",65% of total billed charges,"$33,173.05 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$26,969.96 ","$83,699.87 ","$37,199.94 "
Inpatient Medical Services,AMBULATORY,470,MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMORBID CONDITIONS OR COMPLICATIONS (MCC).,360,"$50,958.38 ","$43,314.62 ",85% of total billed charges,"$39,237.95 ",77% of total billed charges,,Not applicable DRG for the associated revenue code,"$41,785.87 ",82% of total billed charges,"$29,811.18 ",85% of total billed charges,"$29,811.18 ",85% of total billed charges,"$29,811.18 ",85% of total billed charges,"$40,766.70 ",90% of total billed charges,"$40,766.70 ",80% of total billed charges,"$45,862.54 ",90% of total billed charges,"$38,218.79 ",75% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,"$34,142.11 ",67% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$40,766.70 ",80% of total billed charges,"$33,122.95 ",65% of total billed charges,"$18,176.85 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$14,777.93 ","$45,862.54 ","$20,383.35 "
Inpatient Medical Services,AMBULATORY,473,CERVICAL SPINAL FUSION WITHOUT COMORBID CONDITIONS (CC) OR MAJOR COMORBID CONDITIONS OR COMPLICATIONS (MCC).,360,"$69,167.28 ","$58,792.19 ",85% of total billed charges,"$53,258.81 ",77% of total billed charges,,Not applicable DRG for the associated revenue code,"$56,717.17 ",82% of total billed charges,"$35,550.79 ",85% of total billed charges,"$35,550.79 ",85% of total billed charges,"$35,550.79 ",85% of total billed charges,"$55,333.82 ",90% of total billed charges,"$55,333.82 ",80% of total billed charges,"$62,250.55 ",90% of total billed charges,"$51,875.46 ",75% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,"$46,342.08 ",67% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$55,333.82 ",80% of total billed charges,"$44,958.73 ",65% of total billed charges,"$24,671.97 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$20,058.51 ","$62,250.55 ","$27,666.91 "
Inpatient Medical Services,AMBULATORY,743,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT COMORBID CONDITIONS (CC) OR MAJOR COMORBID CONDITIONS OR COMPLICATIONS (MCC),360,"$17,997.20 ","$15,297.62 ",85% of total billed charges,"$13,857.84 ",77% of total billed charges,,Not applicable DRG for the associated revenue code,"$14,757.70 ",82% of total billed charges,"$16,713.92 ",85% of total billed charges,"$16,713.92 ",85% of total billed charges,"$16,713.92 ",85% of total billed charges,"$16,197.48 ",90% of total billed charges,"$14,397.76 ",80% of total billed charges,"$16,197.48 ",90% of total billed charges,"$13,497.90 ",75% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,"$12,058.12 ",67% of total billed charges,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$14,397.76 ",80% of total billed charges,"$11,698.18 ",65% of total billed charges,"$6,419.60 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,,Not applicable DRG for the associated revenue code,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,219.19 ","$16,713.92 ","$7,198.88 "
Outpatient Medical Services,AMBULATORY,19120,"REMOVAL OF 1 OR MORE BREAST GROWTH, OPEN PROCEDURE",360,"$10,146.76 ","$1,150.00 ",CASE RATE,"$7,813.01 ",77% of total billed charges,"$3,155.41 ",100% of Medicare outpatient rates,"$12,684.46 ",465% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$9,132.08 ",90% of total billed charges,"$8,117.41 ",80% of total billed charges,"$9,132.08 ",90% of total billed charges,"$7,610.07 ",75% of total billed charges,"$3,849.60 ",100% of Medicare outpatient rates,"$3,849.60 ",100% of Medicare outpatient rates,"$3,849.60 ",100% of Medicare outpatient rates,$963.66 ,100% TX Medicaid ASC fee schedule,"$3,155.41 ",100% of Medicare outpatient rates,"$6,798.33 ",67% of total billed charges,"$1,663.22 ",105% of 2012 Medicare outpatient rates,"$2,524.33 ",80% of Medicare outpatient rates,"$8,117.41 ",80% of total billed charges,"$6,595.39 ",65% of total billed charges,"$1,185.30 ",123% TX Medicaid ASC fee schedule,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,"$13,230.02 ","$4,058.70 "
Outpatient Medical Services,AMBULATORY,29826,SHAVING OF SHOULDER BONE USING AN ENDOSCOPE,360,"$20,378.38 ","$1,150.00 ",CASE RATE,"$15,691.35 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$16,710.27 ",82% of total billed charges,"$17,321.62 ",85% of total billed charges,"$17,321.62 ",85% of total billed charges,"$17,321.62 ",85% of total billed charges,"$18,340.54 ",90% of total billed charges,"$16,302.70 ",80% of total billed charges,"$18,340.54 ",90% of total billed charges,"$15,283.79 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$13,653.51 ",67% of total billed charges,"$4,511.01 ",105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,"$16,302.70 ",80% of total billed charges,"$13,245.95 ",65% of total billed charges,"$7,268.97 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,909.73 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,150.00 ","$18,340.54 ","$8,151.35 "
Outpatient Medical Services,AMBULATORY,29881,REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE,360,"$16,095.39 ","$1,500.00 ",CASE RATE,"$12,393.45 ",77% of total billed charges,"$2,732.15 ",100% of Medicare outpatient rates,"$12,300.32 ",465% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$14,485.85 ",90% of total billed charges,"$12,876.31 ",80% of total billed charges,"$14,485.85 ",90% of total billed charges,"$12,071.54 ",75% of total billed charges,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,"$10,783.91 ",67% of total billed charges,"$1,933.94 ",105% of 2012 Medicare outpatient rates,"$2,185.71 ",80% of Medicare outpatient rates,"$12,876.31 ",80% of total billed charges,"$10,462.00 ",65% of total billed charges,"$1,338.57 ",123% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ","$14,485.85 ","$6,438.16 "
Outpatient Medical Services,AMBULATORY,42820,REMOVAL OF TONSILS AND ADENOID GLANDS PATIENT YOUNGER THAN AGE 12,360,"$10,800.40 ","$1,150.00 ",CASE RATE,"$8,316.31 ",77% of total billed charges,"$4,901.06 ",100% of Medicare outpatient rates,"$20,175.37 ",465% BCBSTX ASC fee schedule rate,"$21,043.13 ",485% BCBSTX ASC fee schedule rate,"$21,043.13 ",485% BCBSTX ASC fee schedule rate,"$21,043.13 ",485% BCBSTX ASC fee schedule rate,"$9,720.36 ",90% of total billed charges,"$8,640.32 ",80% of total billed charges,"$9,720.36 ",90% of total billed charges,"$8,100.30 ",75% of total billed charges,"$5,979.29 ",100% of Medicare outpatient rates,"$5,979.29 ",100% of Medicare outpatient rates,"$5,979.29 ",100% of Medicare outpatient rates,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$4,901.06 ",100% of Medicare outpatient rates,"$7,236.27 ",67% of total billed charges,"$1,624.47 ",105% of 2012 Medicare outpatient rates,"$3,920.85 ",80% of Medicare outpatient rates,"$8,640.32 ",80% of total billed charges,"$7,020.26 ",65% of total billed charges,"$2,403.69 ",123% TX Medicaid ASC fee schedule,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$4,901.06 ",100% of Medicare outpatient rates,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,954.22 ",100% TX Medicaid ASC fee schedule,"$1,150.00 ","$21,043.13 ","$4,320.16 "
Outpatient Medical Services,AMBULATORY,43235,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",360,"$7,318.48 ","$1,150.00 ",CASE RATE,"$5,635.23 ",77% of total billed charges,$757.70 ,100% of Medicare outpatient rates,"$3,457.23 ",465% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$6,586.63 ",90% of total billed charges,"$5,854.78 ",80% of total billed charges,"$6,586.63 ",90% of total billed charges,"$5,488.86 ",75% of total billed charges,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,"$4,903.38 ",67% of total billed charges,$551.11 ,105% of 2012 Medicare outpatient rates,$606.15 ,80% of Medicare outpatient rates,"$5,854.78 ",80% of total billed charges,"$4,757.01 ",65% of total billed charges,$411.99 ,123% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,"$6,586.63 ","$2,927.39 "
Outpatient Medical Services,AMBULATORY,43239,"BIOPSY OF THE ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",360,"$9,945.00 ","$1,150.00 ",CASE RATE,"$7,657.65 ",77% of total billed charges,$757.70 ,100% of Medicare outpatient rates,"$3,457.23 ",465% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$8,950.50 ",90% of total billed charges,"$7,956.00 ",80% of total billed charges,"$8,950.50 ",90% of total billed charges,"$7,458.75 ",75% of total billed charges,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,"$6,663.15 ",67% of total billed charges,$551.11 ,105% of 2012 Medicare outpatient rates,$606.15 ,80% of Medicare outpatient rates,"$7,956.00 ",80% of total billed charges,"$6,464.25 ",65% of total billed charges,$411.99 ,123% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,"$8,950.50 ","$3,978.00 "
Outpatient Medical Services,AMBULATORY,45378,DIAGNOSTIC EXAMINATION OF LARGE BOWEL USING AN ENDOSCOPE,360,"$7,941.96 ","$1,150.00 ",CASE RATE,"$6,115.31 ",77% of total billed charges,$762.77 ,100% of Medicare outpatient rates,"$3,301.41 ",465% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$7,147.76 ",90% of total billed charges,"$6,353.57 ",80% of total billed charges,"$7,147.76 ",90% of total billed charges,"$5,956.47 ",75% of total billed charges,$930.58 ,100% of Medicare outpatient rates,$930.58 ,100% of Medicare outpatient rates,$930.58 ,100% of Medicare outpatient rates,$328.50 ,100% TX Medicaid ASC fee schedule,$762.77 ,100% of Medicare outpatient rates,"$5,321.11 ",67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$610.22 ,80% of Medicare outpatient rates,"$6,353.57 ",80% of total billed charges,"$5,162.27 ",65% of total billed charges,$404.06 ,123% TX Medicaid ASC fee schedule,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,"$7,147.76 ","$3,176.78 "
Outpatient Medical Services,AMBULATORY,45380,BIOPSY OF LARGE BOWEL USING AN ENDOSCOPE,360,"$8,149.96 ","$1,150.00 ",CASE RATE,"$6,275.47 ",77% of total billed charges,$993.96 ,100% of Medicare outpatient rates,"$4,354.21 ",465% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$7,334.96 ",90% of total billed charges,"$6,519.97 ",80% of total billed charges,"$7,334.96 ",90% of total billed charges,"$6,112.47 ",75% of total billed charges,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,"$5,460.47 ",67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$795.16 ,80% of Medicare outpatient rates,"$6,519.97 ",80% of total billed charges,"$5,297.47 ",65% of total billed charges,$527.99 ,123% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,"$7,334.96 ","$3,259.98 "
Outpatient Medical Services,AMBULATORY,45385,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE,360,"$7,969.00 ","$1,150.00 ",CASE RATE,"$6,136.13 ",77% of total billed charges,$993.96 ,100% of Medicare outpatient rates,"$4,354.21 ",465% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$7,172.10 ",90% of total billed charges,"$6,375.20 ",80% of total billed charges,"$7,172.10 ",90% of total billed charges,"$5,976.75 ",75% of total billed charges,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,"$5,339.23 ",67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$795.16 ,80% of Medicare outpatient rates,"$6,375.20 ",80% of total billed charges,"$5,179.85 ",65% of total billed charges,$527.99 ,123% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,"$7,172.10 ","$3,187.60 "
Outpatient Medical Services,AMBULATORY,47562,REMOVAL OF GALLBLADDER USING AN ENDOSCOPE,360,"$23,510.24 ","$2,000.00 ",CASE RATE,"$18,102.88 ",77% of total billed charges,"$4,784.01 ",100% of Medicare outpatient rates,"$20,872.36 ",465% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,159.22 ",90% of total billed charges,"$18,808.19 ",80% of total billed charges,"$21,159.22 ",90% of total billed charges,"$17,632.68 ",75% of total billed charges,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,"$15,751.86 ",67% of total billed charges,"$5,316.73 ",105% of 2012 Medicare outpatient rates,"$3,827.21 ",80% of Medicare outpatient rates,"$18,808.19 ",80% of total billed charges,"$15,281.66 ",65% of total billed charges,"$2,323.29 ",123% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ","$21,770.10 ","$9,404.10 "
Outpatient Medical Services,AMBULATORY,49505,REPAIR OF GROIN HERNIA PATIENT AGE 5 YEARS OR OLDER,360,"$10,985.00 ","$1,150.00 ",CASE RATE,"$8,458.45 ",77% of total billed charges,"$3,250.99 ",100% of Medicare outpatient rates,"$13,536.89 ",465% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$9,886.50 ",90% of total billed charges,"$8,788.00 ",80% of total billed charges,"$9,886.50 ",90% of total billed charges,"$8,238.75 ",75% of total billed charges,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$7,359.95 ",67% of total billed charges,"$2,147.37 ",105% of 2012 Medicare outpatient rates,"$2,600.79 ",80% of Medicare outpatient rates,"$8,788.00 ",80% of total billed charges,"$7,140.25 ",65% of total billed charges,"$1,416.39 ",123% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,150.00 ","$14,119.13 ","$4,394.00 "
Outpatient Medical Services,AMBULATORY,55700,BIOPSY OF PROSTATE GLAND,360,"$13,629.20 ","$1,150.00 ",CASE RATE,"$10,494.48 ",77% of total billed charges,"$1,702.52 ",100% of Medicare outpatient rates,"$7,884.91 ",465% BCBSTX ASC fee schedule rate,"$8,224.05 ",485% BCBSTX ASC fee schedule rate,"$8,224.05 ",485% BCBSTX ASC fee schedule rate,"$8,224.05 ",485% BCBSTX ASC fee schedule rate,"$12,266.28 ",90% of total billed charges,"$10,903.36 ",80% of total billed charges,"$12,266.28 ",90% of total billed charges,"$10,221.90 ",75% of total billed charges,"$2,077.07 ",100% of Medicare outpatient rates,"$2,077.07 ",100% of Medicare outpatient rates,"$2,077.07 ",100% of Medicare outpatient rates,$652.80 ,100% TX Medicaid ASC fee schedule,"$1,702.52 ",100% of Medicare outpatient rates,"$9,131.56 ",67% of total billed charges,$902.51 ,105% of 2012 Medicare outpatient rates,"$1,362.01 ",80% of Medicare outpatient rates,"$10,903.36 ",80% of total billed charges,"$8,858.98 ",65% of total billed charges,$802.94 ,123% TX Medicaid ASC fee schedule,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,"$1,702.52 ",100% of Medicare outpatient rates,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,100% TX Medicaid ASC fee schedule,$652.80 ,"$12,266.28 ","$5,451.68 "
Outpatient Medical Services,AMBULATORY,59400,"ROUTINE OBSTETRIC CARE FOR VAGINAL DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE",360,"$28,366.00 ","$1,150.00 ",CASE RATE,"$21,841.82 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$9,999.59 ",465% BCBSTX ASC fee schedule rate,"$10,429.68 ",485% BCBSTX ASC fee schedule rate,"$10,429.68 ",485% BCBSTX ASC fee schedule rate,"$10,429.68 ",485% BCBSTX ASC fee schedule rate,"$25,529.40 ",90% of total billed charges,"$22,692.80 ",80% of total billed charges,"$25,529.40 ",90% of total billed charges,"$21,274.50 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$19,005.22 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$22,692.80 ",80% of total billed charges,"$18,437.90 ",65% of total billed charges,"$10,118.15 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,150.00 ","$25,529.40 ","$11,346.40 "
Outpatient Medical Services,AMBULATORY,59610,ROUTINE OBSTETRIC CARE FOR VAGINAL DELIVERY AFTER PRIOR CESAREAN DELIVERY INCLUDING PRE-AND POST-DELIVERY CARE,360,"$28,366.00 ","$1,150.00 ",CASE RATE,"$21,841.82 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$10,526.95 ",465% BCBSTX ASC fee schedule rate,"$10,979.72 ",485% BCBSTX ASC fee schedule rate,"$10,979.72 ",485% BCBSTX ASC fee schedule rate,"$10,979.72 ",485% BCBSTX ASC fee schedule rate,"$25,529.40 ",90% of total billed charges,"$22,692.80 ",80% of total billed charges,"$25,529.40 ",90% of total billed charges,"$21,274.50 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$19,005.22 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$22,692.80 ",80% of total billed charges,"$18,437.90 ",65% of total billed charges,"$10,118.15 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$8,226.14 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,150.00 ","$25,529.40 ","$11,346.40 "
Outpatient Medical Services,AMBULATORY,62322,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF LOWER BACK OR SACRUM USING IMAGING GUIDANCE,360,"$12,094.16 ","$1,150.00 ",CASE RATE,"$9,312.50 ",77% of total billed charges,$782.18 ,100% of Medicare outpatient rates,"$2,526.72 ",465% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$10,884.74 ",90% of total billed charges,"$9,675.33 ",80% of total billed charges,"$10,884.74 ",90% of total billed charges,"$9,070.62 ",75% of total billed charges,$954.25 ,100% of Medicare outpatient rates,$954.25 ,100% of Medicare outpatient rates,$954.25 ,100% of Medicare outpatient rates,$262.86 ,100% TX Medicaid ASC fee schedule,$782.18 ,100% of Medicare outpatient rates,"$8,103.09 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$625.74 ,80% of Medicare outpatient rates,"$9,675.33 ",80% of total billed charges,"$7,861.20 ",65% of total billed charges,$323.32 ,123% TX Medicaid ASC fee schedule,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,"$10,884.74 ","$4,837.66 "
Outpatient Medical Services,AMBULATORY,62323,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF LOWER BACK OR SACRUM USING IMAGING GUIDANCE,360,"$6,043.96 ","$1,150.00 ",CASE RATE,"$4,653.85 ",77% of total billed charges,$591.41 ,100% of Medicare outpatient rates,"$2,526.72 ",465% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$2,635.39 ",485% BCBSTX ASC fee schedule rate,"$5,439.56 ",90% of total billed charges,"$4,835.17 ",80% of total billed charges,"$5,439.56 ",90% of total billed charges,"$4,532.97 ",75% of total billed charges,$721.52 ,100% of Medicare outpatient rates,$721.52 ,100% of Medicare outpatient rates,$721.52 ,100% of Medicare outpatient rates,$262.86 ,100% TX Medicaid ASC fee schedule,$591.41 ,100% of Medicare outpatient rates,"$4,049.45 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$473.12 ,80% of Medicare outpatient rates,"$4,835.17 ",80% of total billed charges,"$3,928.57 ",65% of total billed charges,$323.32 ,123% TX Medicaid ASC fee schedule,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$591.41 ,100% of Medicare outpatient rates,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,100% TX Medicaid ASC fee schedule,$262.86 ,"$5,439.56 ","$2,417.58 "
Outpatient Medical Services,AMBULATORY,64483,INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE,360,"$8,148.40 ","$1,150.00 ",CASE RATE,"$6,274.27 ",77% of total billed charges,$782.18 ,100% of Medicare outpatient rates,"$3,125.64 ",465% BCBSTX ASC fee schedule rate,"$3,260.07 ",485% BCBSTX ASC fee schedule rate,"$3,260.07 ",485% BCBSTX ASC fee schedule rate,"$3,260.07 ",485% BCBSTX ASC fee schedule rate,"$7,333.56 ",90% of total billed charges,"$6,518.72 ",80% of total billed charges,"$7,333.56 ",90% of total billed charges,"$6,111.30 ",75% of total billed charges,$954.25 ,100% of Medicare outpatient rates,$954.25 ,100% of Medicare outpatient rates,$954.25 ,100% of Medicare outpatient rates,$340.77 ,100% TX Medicaid ASC fee schedule,$782.18 ,100% of Medicare outpatient rates,"$5,459.43 ",67% of total billed charges,$487.40 ,105% of 2012 Medicare outpatient rates,$625.74 ,80% of Medicare outpatient rates,"$6,518.72 ",80% of total billed charges,"$5,296.46 ",65% of total billed charges,$419.15 ,123% TX Medicaid ASC fee schedule,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$782.18 ,100% of Medicare outpatient rates,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,100% TX Medicaid ASC fee schedule,$340.77 ,"$7,333.56 ","$3,259.36 "
Outpatient Medical Services,AMBULATORY,66984,REMOVAL OF CATARACT WITH INSERTION OF LENS,360,"$8,148.40 ","$1,150.00 ",CASE RATE,"$6,274.27 ",77% of total billed charges,"$1,982.06 ",100% of Medicare outpatient rates,"$8,933.07 ",465% BCBSTX ASC fee schedule rate,"$9,317.29 ",485% BCBSTX ASC fee schedule rate,"$9,317.29 ",485% BCBSTX ASC fee schedule rate,"$9,317.29 ",485% BCBSTX ASC fee schedule rate,"$7,333.56 ",90% of total billed charges,"$6,518.72 ",80% of total billed charges,"$7,333.56 ",90% of total billed charges,"$6,111.30 ",75% of total billed charges,"$2,418.11 ",100% of Medicare outpatient rates,"$2,418.11 ",100% of Medicare outpatient rates,"$2,418.11 ",100% of Medicare outpatient rates,$849.94 ,100% TX Medicaid ASC fee schedule,"$1,982.06 ",100% of Medicare outpatient rates,"$5,459.43 ",67% of total billed charges,"$1,557.13 ",105% of 2012 Medicare outpatient rates,"$1,585.64 ",80% of Medicare outpatient rates,"$6,518.72 ",80% of total billed charges,"$5,296.46 ",65% of total billed charges,"$1,045.43 ",123% TX Medicaid ASC fee schedule,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,"$1,982.06 ",100% of Medicare outpatient rates,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,100% TX Medicaid ASC fee schedule,$849.94 ,"$9,317.29 ","$3,259.36 "
Outpatient Medical Services,AMBULATORY,94010,PULMONARY FUNCTION TEST,460,$655.00 ,$556.75 ,85% of total billed charges,$504.35 ,77% of total billed charges,$133.48 ,100% of Medicare outpatient rates,$584.81 ,429% BCBSTX Other fee schedule,$609.35 ,447% BCBSTX Other fee schedule,$609.35 ,447% BCBSTX Other fee schedule,$609.35 ,447% BCBSTX Other fee schedule,$589.50 ,90% of total billed charges,$524.00 ,80% of total billed charges,$589.50 ,90% of total billed charges,$491.25 ,75% of total billed charges,$162.85 ,100% of Medicare outpatient rates,$162.85 ,100% of Medicare outpatient rates,$162.85 ,100% of Medicare outpatient rates,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$133.48 ,100% of Medicare outpatient rates,$438.85 ,67% of total billed charges,$48.24 ,105% of 2012 Medicare outpatient rates,$106.78 ,80% of Medicare outpatient rates,$524.00 ,80% of total billed charges,$425.75 ,65% of total billed charges,$233.64 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$133.48 ,100% of Medicare outpatient rates,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.95 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$48.24 ,$609.35 ,$262.00 
Outpatient Medical Services,AMBULATORY,97606,WOUND CARE VAC,761,$837.00 ,$711.45 ,85% of total billed charges,$644.49 ,77% of total billed charges,$342.42 ,100% of Medicare outpatient rates,"$1,333.33 ",429% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,$753.30 ,90% of total billed charges,$669.60 ,80% of total billed charges,$753.30 ,90% of total billed charges,$627.75 ,75% of total billed charges,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$560.79 ,67% of total billed charges,$97.74 ,105% of 2012 Medicare outpatient rates,$273.94 ,80% of Medicare outpatient rates,$669.60 ,80% of total billed charges,$544.05 ,65% of total billed charges,$298.56 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$242.73 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$97.74 ,"$1,389.28 ",$334.80 
Outpatient Medical Services,AMBULATORY,99406,SMOKE/TOBACCO COUNSEL 3-10 MIN,942,$67.00 ,$56.95 ,85% of total billed charges,$51.59 ,77% of total billed charges,$27.24 ,100% of Medicare outpatient rates,$53.88 ,429% BCBSTX Other fee schedule,$56.14 ,447% BCBSTX Other fee schedule,$56.14 ,447% BCBSTX Other fee schedule,$56.14 ,447% BCBSTX Other fee schedule,$60.30 ,90% of total billed charges,$53.60 ,80% of total billed charges,$60.30 ,90% of total billed charges,$50.25 ,75% of total billed charges,$33.22 ,100% of Medicare outpatient rates,$33.22 ,100% of Medicare outpatient rates,$33.22 ,100% of Medicare outpatient rates,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.24 ,100% of Medicare outpatient rates,$44.89 ,67% of total billed charges,$19.53 ,105% of 2012 Medicare outpatient rates,$21.79 ,80% of Medicare outpatient rates,$53.60 ,80% of total billed charges,$43.55 ,65% of total billed charges,$23.90 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,$60.30 ,$26.80 
Outpatient Medical Services,AMBULATORY,99407,SMOKE/TOBACCO COUNSEL >10 MIN,942,$67.00 ,$56.95 ,85% of total billed charges,$51.59 ,77% of total billed charges,$27.24 ,100% of Medicare outpatient rates,$112.40 ,429% BCBSTX Other fee schedule,$117.11 ,447% BCBSTX Other fee schedule,$117.11 ,447% BCBSTX Other fee schedule,$117.11 ,447% BCBSTX Other fee schedule,$60.30 ,90% of total billed charges,$53.60 ,80% of total billed charges,$60.30 ,90% of total billed charges,$50.25 ,75% of total billed charges,$33.22 ,100% of Medicare outpatient rates,$33.22 ,100% of Medicare outpatient rates,$33.22 ,100% of Medicare outpatient rates,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.24 ,100% of Medicare outpatient rates,$44.89 ,67% of total billed charges,$19.53 ,105% of 2012 Medicare outpatient rates,$21.79 ,80% of Medicare outpatient rates,$53.60 ,80% of total billed charges,$43.55 ,65% of total billed charges,$23.90 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$27.24 ,100% of Medicare outpatient rates,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$19.43 ,$117.11 ,$26.80 
Outpatient Medical Services,CARDIO,93005,EKG WITHOUT INTERPRETATION,730,$268.00 ,$227.80 ,85% of total billed charges,$206.36 ,77% of total billed charges,$52.75 ,100% of Medicare outpatient rates,$240.07 ,429% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$241.20 ,90% of total billed charges,$214.40 ,80% of total billed charges,$241.20 ,90% of total billed charges,$201.00 ,75% of total billed charges,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.75 ,100% of Medicare outpatient rates,$179.56 ,67% of total billed charges,$24.92 ,105% of 2012 Medicare outpatient rates,$42.20 ,80% of Medicare outpatient rates,$214.40 ,80% of total billed charges,$174.20 ,65% of total billed charges,$95.60 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$77.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$24.92 ,$250.14 ,$107.20 
Outpatient Medical Services,CARDIO,93041,RHYTHM STRIP,730,$263.00 ,$223.55 ,85% of total billed charges,$202.51 ,77% of total billed charges,$52.75 ,100% of Medicare outpatient rates,$240.07 ,429% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$236.70 ,90% of total billed charges,$210.40 ,80% of total billed charges,$236.70 ,90% of total billed charges,$197.25 ,75% of total billed charges,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.75 ,100% of Medicare outpatient rates,$176.21 ,67% of total billed charges,$17.54 ,105% of 2012 Medicare outpatient rates,$42.20 ,80% of Medicare outpatient rates,$210.40 ,80% of total billed charges,$170.95 ,65% of total billed charges,$93.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$76.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$17.54 ,$250.14 ,$105.20 
Outpatient Medical Services,CARDIO,93278,SIGNAL AVERAGE EKG,730,$264.00 ,$224.40 ,85% of total billed charges,$203.28 ,77% of total billed charges,$52.75 ,100% of Medicare outpatient rates,$240.07 ,429% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$237.60 ,90% of total billed charges,$211.20 ,80% of total billed charges,$237.60 ,90% of total billed charges,$198.00 ,75% of total billed charges,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$29.08 ,100% TX Medicaid Rad fee schedule,$52.75 ,100% of Medicare outpatient rates,$176.88 ,67% of total billed charges,$17.54 ,105% of 2012 Medicare outpatient rates,$42.20 ,80% of Medicare outpatient rates,$211.20 ,80% of total billed charges,$171.60 ,65% of total billed charges,$35.77 ,123% TX Medicaid Rad fee schedule,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$17.54 ,$250.14 ,$105.60 
Outpatient Medical Services,CARDIO,93225,HOLTER MONITOR APPL.,731,$504.00 ,$428.40 ,85% of total billed charges,$388.08 ,77% of total billed charges,$106.57 ,100% of Medicare outpatient rates,$450.62 ,429% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$453.60 ,90% of total billed charges,$403.20 ,80% of total billed charges,$453.60 ,90% of total billed charges,$378.00 ,75% of total billed charges,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$337.68 ,67% of total billed charges,$60.95 ,105% of 2012 Medicare outpatient rates,$85.25 ,80% of Medicare outpatient rates,$403.20 ,80% of total billed charges,$327.60 ,65% of total billed charges,$179.78 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$146.16 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$60.95 ,$469.53 ,$201.60 
Outpatient Medical Services,CARDIO,93226,HOLTER MONITOR ANALYSIS/REPORT,731,$494.00 ,$419.90 ,85% of total billed charges,$380.38 ,77% of total billed charges,$106.57 ,100% of Medicare outpatient rates,$450.62 ,429% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$444.60 ,90% of total billed charges,$395.20 ,80% of total billed charges,$444.60 ,90% of total billed charges,$370.50 ,75% of total billed charges,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$330.98 ,67% of total billed charges,$60.95 ,105% of 2012 Medicare outpatient rates,$85.25 ,80% of Medicare outpatient rates,$395.20 ,80% of total billed charges,$321.10 ,65% of total billed charges,$176.21 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$143.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$60.95 ,$469.53 ,$197.60 
Outpatient Medical Services,CARDIO,93278,SIGNAL AVERAGE EKG,730,$264.00 ,$224.40 ,85% of total billed charges,$203.28 ,77% of total billed charges,$52.75 ,100% of Medicare outpatient rates,$240.07 ,429% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$250.14 ,447% BCBSTX Other fee schedule,$237.60 ,90% of total billed charges,$211.20 ,80% of total billed charges,$237.60 ,90% of total billed charges,$198.00 ,75% of total billed charges,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$64.36 ,100% of Medicare outpatient rates,$29.08 ,100% TX Medicaid Rad fee schedule,$52.75 ,100% of Medicare outpatient rates,$176.88 ,67% of total billed charges,$17.54 ,105% of 2012 Medicare outpatient rates,$42.20 ,80% of Medicare outpatient rates,$211.20 ,80% of total billed charges,$171.60 ,65% of total billed charges,$35.77 ,123% TX Medicaid Rad fee schedule,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$52.75 ,100% of Medicare outpatient rates,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$29.08 ,100% TX Medicaid Rad fee schedule,$17.54 ,$250.14 ,$105.60 
Outpatient Medical Services,CARDIO,93797,CARDIAC REHAB W/OUT MONITORING,943,$286.00 ,$243.10 ,85% of total billed charges,$220.22 ,77% of total billed charges,$110.20 ,100% of Medicare outpatient rates,$38.48 ,429% BCBSTX Other fee schedule,$40.10 ,447% BCBSTX Other fee schedule,$40.10 ,447% BCBSTX Other fee schedule,$40.10 ,447% BCBSTX Other fee schedule,$257.40 ,90% of total billed charges,$228.80 ,80% of total billed charges,$257.40 ,90% of total billed charges,$214.50 ,75% of total billed charges,$134.44 ,100% of Medicare outpatient rates,$134.44 ,100% of Medicare outpatient rates,$134.44 ,100% of Medicare outpatient rates,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,100% of Medicare outpatient rates,$191.62 ,67% of total billed charges,$64.88 ,105% of 2012 Medicare outpatient rates,$88.16 ,80% of Medicare outpatient rates,$228.80 ,80% of total billed charges,$185.90 ,65% of total billed charges,$102.02 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$38.48 ,$257.40 ,$114.40 
Outpatient Medical Services,CARDIO,93798,CARDIAC REHAB WITH MONITORING,943,$286.00 ,$243.10 ,85% of total billed charges,$220.22 ,77% of total billed charges,$110.20 ,100% of Medicare outpatient rates,$61.60 ,429% BCBSTX Other fee schedule,$64.19 ,447% BCBSTX Other fee schedule,$64.19 ,447% BCBSTX Other fee schedule,$64.19 ,447% BCBSTX Other fee schedule,$257.40 ,90% of total billed charges,$228.80 ,80% of total billed charges,$257.40 ,90% of total billed charges,$214.50 ,75% of total billed charges,$134.44 ,100% of Medicare outpatient rates,$134.44 ,100% of Medicare outpatient rates,$134.44 ,100% of Medicare outpatient rates,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,100% of Medicare outpatient rates,$191.62 ,67% of total billed charges,$64.88 ,105% of 2012 Medicare outpatient rates,$88.16 ,80% of Medicare outpatient rates,$228.80 ,80% of total billed charges,$185.90 ,65% of total billed charges,$102.02 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$110.20 ,100% of Medicare outpatient rates,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$82.94 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$61.60 ,$257.40 ,$114.40 
Outpatient Medical Services,EMERGENCY ROOM,99281,EMERGENCY ROOM LEVEL 1,450,$412.00 ,$350.20 ,85% of total billed charges,$317.24 ,77% of total billed charges,$68.92 ,100% of Medicare outpatient rates,$376.94 ,ER CASE RATE,$392.74 ,ER CASE RATE,$392.74 ,ER CASE RATE,$392.74 ,ER CASE RATE,$370.80 ,90% of total billed charges,$329.60 ,80% of total billed charges,$370.80 ,90% of total billed charges,$309.00 ,75% of total billed charges,$84.07 ,100% of Medicare outpatient rates,$84.07 ,100% of Medicare outpatient rates,$84.07 ,100% of Medicare outpatient rates,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$68.92 ,100% of Medicare outpatient rates,$276.04 ,67% of total billed charges,$46.82 ,105% of 2012 Medicare outpatient rates,$55.13 ,80% of Medicare outpatient rates,$329.60 ,80% of total billed charges,$267.80 ,65% of total billed charges,$146.96 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$68.92 ,100% of Medicare outpatient rates,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$119.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$46.82 ,$392.74 ,$164.80 
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY ROOM LEVEL 2,450,$748.00 ,$635.80 ,85% of total billed charges,$575.96 ,77% of total billed charges,$128.21 ,100% of Medicare outpatient rates,$684.33 ,ER CASE RATE,$713.00 ,ER CASE RATE,$713.00 ,ER CASE RATE,$713.00 ,ER CASE RATE,$673.20 ,90% of total billed charges,$598.40 ,80% of total billed charges,$673.20 ,90% of total billed charges,$561.00 ,75% of total billed charges,$156.41 ,100% of Medicare outpatient rates,$156.41 ,100% of Medicare outpatient rates,$156.41 ,100% of Medicare outpatient rates,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$128.21 ,100% of Medicare outpatient rates,$501.16 ,67% of total billed charges,$80.59 ,105% of 2012 Medicare outpatient rates,$102.57 ,80% of Medicare outpatient rates,$598.40 ,80% of total billed charges,$486.20 ,65% of total billed charges,$266.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$128.21 ,100% of Medicare outpatient rates,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$216.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$80.59 ,$713.00 ,$299.20 
Outpatient Medical Services,EMERGENCY ROOM,99283,EMERGENCY ROOM LEVEL 3,450,"$1,317.00 ","$1,119.45 ",85% of total billed charges,"$1,014.09 ",77% of total billed charges,$224.90 ,100% of Medicare outpatient rates,"$1,202.86 ",ER CASE RATE,"$1,253.26 ",ER CASE RATE,"$1,253.26 ",ER CASE RATE,"$1,253.26 ",ER CASE RATE,"$1,185.30 ",90% of total billed charges,"$1,053.60 ",80% of total billed charges,"$1,185.30 ",90% of total billed charges,$987.75 ,75% of total billed charges,$274.37 ,100% of Medicare outpatient rates,$274.37 ,100% of Medicare outpatient rates,$274.37 ,100% of Medicare outpatient rates,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$224.90 ,100% of Medicare outpatient rates,$882.39 ,67% of total billed charges,$126.81 ,105% of 2012 Medicare outpatient rates,$179.91 ,80% of Medicare outpatient rates,"$1,053.60 ",80% of total billed charges,$856.05 ,65% of total billed charges,$469.77 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$224.90 ,100% of Medicare outpatient rates,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$381.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.81 ,"$1,253.26 ",$526.80 
Outpatient Medical Services,EMERGENCY ROOM,99284,EMERGENCY ROOM LEVEL 4,450,"$2,135.00 ","$1,814.75 ",85% of total billed charges,"$1,643.95 ",77% of total billed charges,$350.26 ,100% of Medicare outpatient rates,"$1,525.22 ",ER CASE RATE,"$1,589.22 ",ER CASE RATE,"$1,589.22 ",ER CASE RATE,"$1,589.22 ",ER CASE RATE,"$1,921.50 ",90% of total billed charges,"$1,708.00 ",80% of total billed charges,"$1,921.50 ",90% of total billed charges,"$1,601.25 ",75% of total billed charges,$427.31 ,100% of Medicare outpatient rates,$427.31 ,100% of Medicare outpatient rates,$427.31 ,100% of Medicare outpatient rates,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$350.26 ,100% of Medicare outpatient rates,"$1,430.45 ",67% of total billed charges,$203.97 ,105% of 2012 Medicare outpatient rates,$280.20 ,80% of Medicare outpatient rates,"$1,708.00 ",80% of total billed charges,"$1,387.75 ",65% of total billed charges,$761.55 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$350.26 ,100% of Medicare outpatient rates,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$619.15 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$203.97 ,"$1,921.50 ",$854.00 
Outpatient Medical Services,EMERGENCY ROOM,99285,EMERGENCY ROOM LEVEL 5,450,"$3,127.00 ","$2,657.95 ",85% of total billed charges,"$2,407.79 ",77% of total billed charges,$503.08 ,100% of Medicare outpatient rates,"$2,859.47 ",ER CASE RATE,"$2,979.26 ",ER CASE RATE,"$2,979.26 ",ER CASE RATE,"$2,979.26 ",ER CASE RATE,"$2,814.30 ",90% of total billed charges,"$2,501.60 ",80% of total billed charges,"$2,814.30 ",90% of total billed charges,"$2,345.25 ",75% of total billed charges,$613.76 ,100% of Medicare outpatient rates,$613.76 ,100% of Medicare outpatient rates,$613.76 ,100% of Medicare outpatient rates,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$503.08 ,100% of Medicare outpatient rates,"$2,095.09 ",67% of total billed charges,$301.36 ,105% of 2012 Medicare outpatient rates,$402.46 ,80% of Medicare outpatient rates,"$2,501.60 ",80% of total billed charges,"$2,032.55 ",65% of total billed charges,"$1,115.40 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$503.08 ,100% of Medicare outpatient rates,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$906.83 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$301.36 ,"$2,979.26 ","$1,250.80 "
Outpatient Medical Services,LAB,80048,BASIC METABOLIC PANEL,300,$125.00 ,$106.25 ,85% of total billed charges,$96.25 ,77% of total billed charges,$8.46 ,100% of Medicare outpatient rates,$36.54 ,350% BCBSTX Lab fee schedule,$38.00 ,364% BCBSTX Lab fee schedule,$38.00 ,364% BCBSTX Lab fee schedule,$38.00 ,364% BCBSTX Lab fee schedule,$112.50 ,90% of total billed charges,$100.00 ,80% of total billed charges,$112.50 ,90% of total billed charges,$93.75 ,75% of total billed charges,$10.32 ,100% of Medicare outpatient rates,$10.32 ,100% of Medicare outpatient rates,$10.32 ,100% of Medicare outpatient rates,$7.11 ,100% TX Medicaid lab fee schedule,$8.46 ,100% of Medicare outpatient rates,$83.75 ,67% of total billed charges,$9.50 ,105% of 2012 Medicare outpatient rates,$6.76 ,80% of Medicare outpatient rates,$100.00 ,80% of total billed charges,$81.25 ,65% of total billed charges,$8.75 ,123% TX Medicaid lab fee schedule,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$8.46 ,100% of Medicare outpatient rates,$7.11 ,100% TX Medicaid lab fee schedule,$7.11 ,100% TX Medicaid lab fee schedule,$7.11 ,100% TX Medicaid lab fee schedule,$7.11 ,100% TX Medicaid lab fee schedule,$7.11 ,100% TX Medicaid lab fee schedule,$7.11 ,100% TX Medicaid lab fee schedule,$6.76 ,$112.50 ,$50.00 
Outpatient Medical Services,LAB,80053,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",300,$165.00 ,$140.25 ,85% of total billed charges,$127.05 ,77% of total billed charges,$10.56 ,100% of Medicare outpatient rates,$45.64 ,350% BCBSTX Lab fee schedule,$47.47 ,364% BCBSTX Lab fee schedule,$47.47 ,364% BCBSTX Lab fee schedule,$47.47 ,364% BCBSTX Lab fee schedule,$148.50 ,90% of total billed charges,$132.00 ,80% of total billed charges,$148.50 ,90% of total billed charges,$123.75 ,75% of total billed charges,$12.88 ,100% of Medicare outpatient rates,$12.88 ,100% of Medicare outpatient rates,$12.88 ,100% of Medicare outpatient rates,$8.87 ,100% TX Medicaid lab fee schedule,$10.56 ,100% of Medicare outpatient rates,$110.55 ,67% of total billed charges,$14.21 ,105% of 2012 Medicare outpatient rates,$8.44 ,80% of Medicare outpatient rates,$132.00 ,80% of total billed charges,$107.25 ,65% of total billed charges,$10.91 ,123% TX Medicaid lab fee schedule,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$10.56 ,100% of Medicare outpatient rates,$8.87 ,100% TX Medicaid lab fee schedule,$8.87 ,100% TX Medicaid lab fee schedule,$8.87 ,100% TX Medicaid lab fee schedule,$8.87 ,100% TX Medicaid lab fee schedule,$8.87 ,100% TX Medicaid lab fee schedule,$8.87 ,100% TX Medicaid lab fee schedule,$8.44 ,$148.50 ,$66.00 
Outpatient Medical Services,LAB,80055,OBSTETRIC BLOOD TEST PANEL,300,$731.00 ,$621.35 ,85% of total billed charges,$562.87 ,77% of total billed charges,$47.81 ,100% of Medicare outpatient rates,$206.57 ,350% BCBSTX Lab fee schedule,$214.83 ,364% BCBSTX Lab fee schedule,$214.83 ,364% BCBSTX Lab fee schedule,$214.83 ,364% BCBSTX Lab fee schedule,$657.90 ,90% of total billed charges,$584.80 ,80% of total billed charges,$657.90 ,90% of total billed charges,$548.25 ,75% of total billed charges,$58.32 ,100% of Medicare outpatient rates,$58.32 ,100% of Medicare outpatient rates,$58.32 ,100% of Medicare outpatient rates,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$47.81 ,100% of Medicare outpatient rates,$489.77 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$38.24 ,80% of Medicare outpatient rates,$584.80 ,80% of total billed charges,$475.15 ,65% of total billed charges,$260.75 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$47.81 ,100% of Medicare outpatient rates,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$211.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$38.24 ,$657.90 ,$292.40 
Outpatient Medical Services,LAB,80061,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",300,$125.00 ,$106.25 ,85% of total billed charges,$96.25 ,77% of total billed charges,$13.39 ,100% of Medicare outpatient rates,$57.86 ,350% BCBSTX Lab fee schedule,$60.17 ,364% BCBSTX Lab fee schedule,$60.17 ,364% BCBSTX Lab fee schedule,$60.17 ,364% BCBSTX Lab fee schedule,$112.50 ,90% of total billed charges,$100.00 ,80% of total billed charges,$112.50 ,90% of total billed charges,$93.75 ,75% of total billed charges,$16.33 ,100% of Medicare outpatient rates,$16.33 ,100% of Medicare outpatient rates,$16.33 ,100% of Medicare outpatient rates,$11.25 ,100% TX Medicaid lab fee schedule,$13.39 ,100% of Medicare outpatient rates,$83.75 ,67% of total billed charges,$19.91 ,105% of 2012 Medicare outpatient rates,$10.71 ,80% of Medicare outpatient rates,$100.00 ,80% of total billed charges,$81.25 ,65% of total billed charges,$13.84 ,123% TX Medicaid lab fee schedule,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$13.39 ,100% of Medicare outpatient rates,$11.25 ,100% TX Medicaid lab fee schedule,$11.25 ,100% TX Medicaid lab fee schedule,$11.25 ,100% TX Medicaid lab fee schedule,$11.25 ,100% TX Medicaid lab fee schedule,$11.25 ,100% TX Medicaid lab fee schedule,$11.25 ,100% TX Medicaid lab fee schedule,$10.71 ,$112.50 ,$50.00 
Outpatient Medical Services,LAB,80069,KIDNEY FUNCTION PANEL TEST,300,$136.00 ,$115.60 ,85% of total billed charges,$104.72 ,77% of total billed charges,$8.68 ,100% of Medicare outpatient rates,$37.52 ,350% BCBSTX Lab fee schedule,$39.02 ,364% BCBSTX Lab fee schedule,$39.02 ,364% BCBSTX Lab fee schedule,$39.02 ,364% BCBSTX Lab fee schedule,$122.40 ,90% of total billed charges,$108.80 ,80% of total billed charges,$122.40 ,90% of total billed charges,$102.00 ,75% of total billed charges,$10.58 ,100% of Medicare outpatient rates,$10.58 ,100% of Medicare outpatient rates,$10.58 ,100% of Medicare outpatient rates,$7.29 ,100% TX Medicaid lab fee schedule,$8.68 ,100% of Medicare outpatient rates,$91.12 ,67% of total billed charges,$11.91 ,105% of 2012 Medicare outpatient rates,$6.94 ,80% of Medicare outpatient rates,$108.80 ,80% of total billed charges,$88.40 ,65% of total billed charges,$8.97 ,123% TX Medicaid lab fee schedule,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$8.68 ,100% of Medicare outpatient rates,$7.29 ,100% TX Medicaid lab fee schedule,$7.29 ,100% TX Medicaid lab fee schedule,$7.29 ,100% TX Medicaid lab fee schedule,$7.29 ,100% TX Medicaid lab fee schedule,$7.29 ,100% TX Medicaid lab fee schedule,$7.29 ,100% TX Medicaid lab fee schedule,$6.94 ,$122.40 ,$54.40 
Outpatient Medical Services,LAB,80076,LIVER FUNCTION BLOOD TEST PANEL,300,$138.00 ,$117.30 ,85% of total billed charges,$106.26 ,77% of total billed charges,$8.17 ,100% of Medicare outpatient rates,$35.32 ,350% BCBSTX Lab fee schedule,$36.73 ,364% BCBSTX Lab fee schedule,$36.73 ,364% BCBSTX Lab fee schedule,$36.73 ,364% BCBSTX Lab fee schedule,$124.20 ,90% of total billed charges,$110.40 ,80% of total billed charges,$124.20 ,90% of total billed charges,$103.50 ,75% of total billed charges,$9.96 ,100% of Medicare outpatient rates,$9.96 ,100% of Medicare outpatient rates,$9.96 ,100% of Medicare outpatient rates,$6.86 ,100% TX Medicaid lab fee schedule,$8.17 ,100% of Medicare outpatient rates,$92.46 ,67% of total billed charges,$9.50 ,105% of 2012 Medicare outpatient rates,$6.53 ,80% of Medicare outpatient rates,$110.40 ,80% of total billed charges,$89.70 ,65% of total billed charges,$8.44 ,123% TX Medicaid lab fee schedule,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$8.17 ,100% of Medicare outpatient rates,$6.86 ,100% TX Medicaid lab fee schedule,$6.86 ,100% TX Medicaid lab fee schedule,$6.86 ,100% TX Medicaid lab fee schedule,$6.86 ,100% TX Medicaid lab fee schedule,$6.86 ,100% TX Medicaid lab fee schedule,$6.86 ,100% TX Medicaid lab fee schedule,$6.53 ,$124.20 ,$55.20 
Outpatient Medical Services,LAB,81000,MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE,300,$53.00 ,$45.05 ,85% of total billed charges,$40.81 ,77% of total billed charges,$4.01 ,100% of Medicare outpatient rates,$14.07 ,350% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$47.70 ,90% of total billed charges,$42.40 ,80% of total billed charges,$47.70 ,90% of total billed charges,$39.75 ,75% of total billed charges,$4.90 ,100% of Medicare outpatient rates,$4.90 ,100% of Medicare outpatient rates,$4.90 ,100% of Medicare outpatient rates,$3.38 ,100% TX Medicaid lab fee schedule,$4.01 ,100% of Medicare outpatient rates,$35.51 ,67% of total billed charges,$4.70 ,105% of 2012 Medicare outpatient rates,$3.21 ,80% of Medicare outpatient rates,$42.40 ,80% of total billed charges,$34.45 ,65% of total billed charges,$4.16 ,123% TX Medicaid lab fee schedule,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.21 ,$47.70 ,$21.20 
Outpatient Medical Services,LAB,81001,MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE,300,$53.00 ,$45.05 ,85% of total billed charges,$40.81 ,77% of total billed charges,$3.17 ,100% of Medicare outpatient rates,$13.72 ,350% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$47.70 ,90% of total billed charges,$42.40 ,80% of total billed charges,$47.70 ,90% of total billed charges,$39.75 ,75% of total billed charges,$3.86 ,100% of Medicare outpatient rates,$3.86 ,100% of Medicare outpatient rates,$3.86 ,100% of Medicare outpatient rates,$2.66 ,100% TX Medicaid lab fee schedule,$3.17 ,100% of Medicare outpatient rates,$35.51 ,67% of total billed charges,$4.70 ,105% of 2012 Medicare outpatient rates,$2.53 ,80% of Medicare outpatient rates,$42.40 ,80% of total billed charges,$34.45 ,65% of total billed charges,$3.27 ,123% TX Medicaid lab fee schedule,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.53 ,$47.70 ,$21.20 
Outpatient Medical Services,LAB,81002,AUTOMATED URINALYSIS TEST,300,$20.00 ,$17.00 ,85% of total billed charges,$15.40 ,77% of total billed charges,$3.48 ,100% of Medicare outpatient rates,$12.18 ,350% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$18.00 ,90% of total billed charges,$16.00 ,80% of total billed charges,$18.00 ,90% of total billed charges,$15.00 ,75% of total billed charges,$4.24 ,100% of Medicare outpatient rates,$4.24 ,100% of Medicare outpatient rates,$4.24 ,100% of Medicare outpatient rates,$2.92 ,100% TX Medicaid lab fee schedule,$3.48 ,100% of Medicare outpatient rates,$13.40 ,67% of total billed charges,$3.80 ,105% of 2012 Medicare outpatient rates,$2.78 ,80% of Medicare outpatient rates,$16.00 ,80% of total billed charges,$13.00 ,65% of total billed charges,$3.59 ,123% TX Medicaid lab fee schedule,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.78 ,$18.00 ,$8.00 
Outpatient Medical Services,LAB,81003,AUTOMATED URINALYSIS TEST,300,$20.00 ,$17.00 ,85% of total billed charges,$15.40 ,77% of total billed charges,$2.25 ,100% of Medicare outpatient rates,$9.70 ,350% BCBSTX Lab fee schedule,$10.08 ,364% BCBSTX Lab fee schedule,$10.08 ,364% BCBSTX Lab fee schedule,$10.08 ,364% BCBSTX Lab fee schedule,$18.00 ,90% of total billed charges,$16.00 ,80% of total billed charges,$18.00 ,90% of total billed charges,$15.00 ,75% of total billed charges,$2.74 ,100% of Medicare outpatient rates,$2.74 ,100% of Medicare outpatient rates,$2.74 ,100% of Medicare outpatient rates,$1.89 ,100% TX Medicaid lab fee schedule,$2.25 ,100% of Medicare outpatient rates,$13.40 ,67% of total billed charges,$3.33 ,105% of 2012 Medicare outpatient rates,$1.80 ,80% of Medicare outpatient rates,$16.00 ,80% of total billed charges,$13.00 ,65% of total billed charges,$2.32 ,123% TX Medicaid lab fee schedule,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$2.25 ,100% of Medicare outpatient rates,$1.89 ,100% TX Medicaid lab fee schedule,$1.89 ,100% TX Medicaid lab fee schedule,$1.89 ,100% TX Medicaid lab fee schedule,$1.89 ,100% TX Medicaid lab fee schedule,$1.89 ,100% TX Medicaid lab fee schedule,$1.89 ,100% TX Medicaid lab fee schedule,$1.80 ,$18.00 ,$8.00 
Outpatient Medical Services,LAB,84153,PSA (PROSTATE SPECIFIC ANTIGEN),300,$295.00 ,$250.75 ,85% of total billed charges,$227.15 ,77% of total billed charges,$18.39 ,100% of Medicare outpatient rates,$79.49 ,350% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$265.50 ,90% of total billed charges,$236.00 ,80% of total billed charges,$265.50 ,90% of total billed charges,$221.25 ,75% of total billed charges,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$197.65 ,67% of total billed charges,$27.36 ,105% of 2012 Medicare outpatient rates,$14.71 ,80% of Medicare outpatient rates,$236.00 ,80% of total billed charges,$191.75 ,65% of total billed charges,$19.00 ,123% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$14.71 ,$265.50 ,$118.00 
Outpatient Medical Services,LAB,84154,PSA (PROSTATE SPECIFIC ANTIGEN),300,$295.00 ,$250.75 ,85% of total billed charges,$227.15 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$241.90 ,350% BCBSTX Lab fee schedule,$250.75 ,364% BCBSTX Lab fee schedule,$250.75 ,364% BCBSTX Lab fee schedule,$250.75 ,364% BCBSTX Lab fee schedule,$265.50 ,90% of total billed charges,$236.00 ,80% of total billed charges,$265.50 ,90% of total billed charges,$221.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$233.05 ,100% TX Medicaid lab fee schedule,,Not separately reimbursible per CMS guidelines,$197.65 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$236.00 ,80% of total billed charges,$191.75 ,65% of total billed charges,$83.46 ,123% TX Medicaid lab fee schedule,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$233.05 ,100% TX Medicaid lab fee schedule,$233.05 ,100% TX Medicaid lab fee schedule,$233.05 ,100% TX Medicaid lab fee schedule,$233.05 ,100% TX Medicaid lab fee schedule,$233.05 ,100% TX Medicaid lab fee schedule,$233.05 ,100% TX Medicaid lab fee schedule,$83.46 ,$265.50 ,$118.00 
Outpatient Medical Services,LAB,84443,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",300,$253.00 ,$215.05 ,85% of total billed charges,$194.81 ,77% of total billed charges,$16.80 ,100% of Medicare outpatient rates,$72.63 ,350% BCBSTX Lab fee schedule,$75.53 ,364% BCBSTX Lab fee schedule,$75.53 ,364% BCBSTX Lab fee schedule,$75.53 ,364% BCBSTX Lab fee schedule,$227.70 ,90% of total billed charges,$202.40 ,80% of total billed charges,$227.70 ,90% of total billed charges,$189.75 ,75% of total billed charges,$20.49 ,100% of Medicare outpatient rates,$20.49 ,100% of Medicare outpatient rates,$20.49 ,100% of Medicare outpatient rates,$14.11 ,100% TX Medicaid lab fee schedule,$16.80 ,100% of Medicare outpatient rates,$169.51 ,67% of total billed charges,$24.99 ,105% of 2012 Medicare outpatient rates,$13.44 ,80% of Medicare outpatient rates,$202.40 ,80% of total billed charges,$164.45 ,65% of total billed charges,$17.36 ,123% TX Medicaid lab fee schedule,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$16.80 ,100% of Medicare outpatient rates,$14.11 ,100% TX Medicaid lab fee schedule,$14.11 ,100% TX Medicaid lab fee schedule,$14.11 ,100% TX Medicaid lab fee schedule,$14.11 ,100% TX Medicaid lab fee schedule,$14.11 ,100% TX Medicaid lab fee schedule,$14.11 ,100% TX Medicaid lab fee schedule,$13.44 ,$227.70 ,$101.20 
Outpatient Medical Services,LAB,85025,"COMPLETE BLOOD CELL COUNT, WITH DIFFERENTIAL WHITE BLOOD CELLS, AUTOMATED",300,$83.00 ,$70.55 ,85% of total billed charges,$63.91 ,77% of total billed charges,$7.77 ,100% of Medicare outpatient rates,$33.57 ,350% BCBSTX Lab fee schedule,$34.91 ,364% BCBSTX Lab fee schedule,$34.91 ,364% BCBSTX Lab fee schedule,$34.91 ,364% BCBSTX Lab fee schedule,$74.70 ,90% of total billed charges,$66.40 ,80% of total billed charges,$74.70 ,90% of total billed charges,$62.25 ,75% of total billed charges,$9.47 ,100% of Medicare outpatient rates,$9.47 ,100% of Medicare outpatient rates,$9.47 ,100% of Medicare outpatient rates,$6.53 ,100% TX Medicaid lab fee schedule,$7.77 ,100% of Medicare outpatient rates,$55.61 ,67% of total billed charges,$11.57 ,105% of 2012 Medicare outpatient rates,$6.21 ,80% of Medicare outpatient rates,$66.40 ,80% of total billed charges,$53.95 ,65% of total billed charges,$8.03 ,123% TX Medicaid lab fee schedule,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$7.77 ,100% of Medicare outpatient rates,$6.53 ,100% TX Medicaid lab fee schedule,$6.53 ,100% TX Medicaid lab fee schedule,$6.53 ,100% TX Medicaid lab fee schedule,$6.53 ,100% TX Medicaid lab fee schedule,$6.53 ,100% TX Medicaid lab fee schedule,$6.53 ,100% TX Medicaid lab fee schedule,$6.21 ,$74.70 ,$33.20 
Outpatient Medical Services,LAB,85027,"COMPLETE BLOOD COUNT, AUTOMATED",300,$78.00 ,$66.30 ,85% of total billed charges,$60.06 ,77% of total billed charges,$6.47 ,100% of Medicare outpatient rates,$27.93 ,350% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$70.20 ,90% of total billed charges,$62.40 ,80% of total billed charges,$70.20 ,90% of total billed charges,$58.50 ,75% of total billed charges,$7.89 ,100% of Medicare outpatient rates,$7.89 ,100% of Medicare outpatient rates,$7.89 ,100% of Medicare outpatient rates,$5.43 ,100% TX Medicaid lab fee schedule,$6.47 ,100% of Medicare outpatient rates,$52.26 ,67% of total billed charges,$8.64 ,105% of 2012 Medicare outpatient rates,$5.17 ,80% of Medicare outpatient rates,$62.40 ,80% of total billed charges,$50.70 ,65% of total billed charges,$6.68 ,123% TX Medicaid lab fee schedule,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.17 ,$70.20 ,$31.20 
Outpatient Medical Services,LAB,85610,"BLOOD TEST, CLOTTING TIME",300,$60.00 ,$51.00 ,85% of total billed charges,$46.20 ,77% of total billed charges,$4.29 ,100% of Medicare outpatient rates,$16.98 ,350% BCBSTX Lab fee schedule,$17.65 ,364% BCBSTX Lab fee schedule,$17.65 ,364% BCBSTX Lab fee schedule,$17.65 ,364% BCBSTX Lab fee schedule,$54.00 ,90% of total billed charges,$48.00 ,80% of total billed charges,$54.00 ,90% of total billed charges,$45.00 ,75% of total billed charges,$5.23 ,100% of Medicare outpatient rates,$5.23 ,100% of Medicare outpatient rates,$5.23 ,100% of Medicare outpatient rates,$3.60 ,100% TX Medicaid lab fee schedule,$4.29 ,100% of Medicare outpatient rates,$40.20 ,67% of total billed charges,$5.83 ,105% of 2012 Medicare outpatient rates,$3.43 ,80% of Medicare outpatient rates,$48.00 ,80% of total billed charges,$39.00 ,65% of total billed charges,$4.43 ,123% TX Medicaid lab fee schedule,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$4.29 ,100% of Medicare outpatient rates,$3.60 ,100% TX Medicaid lab fee schedule,$3.60 ,100% TX Medicaid lab fee schedule,$3.60 ,100% TX Medicaid lab fee schedule,$3.60 ,100% TX Medicaid lab fee schedule,$3.60 ,100% TX Medicaid lab fee schedule,$3.60 ,100% TX Medicaid lab fee schedule,$3.43 ,$54.00 ,$24.00 
Outpatient Medical Services,LAB,85730,COAGULATION ASSESSMENT BLOOD TEST,300,$81.00 ,$68.85 ,85% of total billed charges,$62.37 ,77% of total billed charges,$6.01 ,100% of Medicare outpatient rates,$25.97 ,350% BCBSTX Lab fee schedule,$27.01 ,364% BCBSTX Lab fee schedule,$27.01 ,364% BCBSTX Lab fee schedule,$27.01 ,364% BCBSTX Lab fee schedule,$72.90 ,90% of total billed charges,$64.80 ,80% of total billed charges,$72.90 ,90% of total billed charges,$60.75 ,75% of total billed charges,$7.33 ,100% of Medicare outpatient rates,$7.33 ,100% of Medicare outpatient rates,$7.33 ,100% of Medicare outpatient rates,$5.05 ,100% TX Medicaid lab fee schedule,$6.01 ,100% of Medicare outpatient rates,$54.27 ,67% of total billed charges,$8.92 ,105% of 2012 Medicare outpatient rates,$4.80 ,80% of Medicare outpatient rates,$64.80 ,80% of total billed charges,$52.65 ,65% of total billed charges,$6.21 ,123% TX Medicaid lab fee schedule,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$6.01 ,100% of Medicare outpatient rates,$5.05 ,100% TX Medicaid lab fee schedule,$5.05 ,100% TX Medicaid lab fee schedule,$5.05 ,100% TX Medicaid lab fee schedule,$5.05 ,100% TX Medicaid lab fee schedule,$5.05 ,100% TX Medicaid lab fee schedule,$5.05 ,100% TX Medicaid lab fee schedule,$4.80 ,$72.90 ,$32.40 
Outpatient Medical Services,LAB,82671,"BLOOD TEST, ESTROGEN",300,$146.00 ,$124.10 ,85% of total billed charges,$112.42 ,77% of total billed charges,$32.29 ,100% of Medicare outpatient rates,$139.58 ,350% BCBSTX Lab fee schedule,$145.16 ,364% BCBSTX Lab fee schedule,$145.16 ,364% BCBSTX Lab fee schedule,$145.16 ,364% BCBSTX Lab fee schedule,$131.40 ,90% of total billed charges,$116.80 ,80% of total billed charges,$131.40 ,90% of total billed charges,$109.50 ,75% of total billed charges,$39.40 ,100% of Medicare outpatient rates,$39.40 ,100% of Medicare outpatient rates,$39.40 ,100% of Medicare outpatient rates,$27.13 ,100% TX Medicaid lab fee schedule,$32.29 ,100% of Medicare outpatient rates,$97.82 ,67% of total billed charges,$48.03 ,105% of 2012 Medicare outpatient rates,$25.84 ,80% of Medicare outpatient rates,$116.80 ,80% of total billed charges,$94.90 ,65% of total billed charges,$33.37 ,123% TX Medicaid lab fee schedule,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$32.29 ,100% of Medicare outpatient rates,$27.13 ,100% TX Medicaid lab fee schedule,$27.13 ,100% TX Medicaid lab fee schedule,$27.13 ,100% TX Medicaid lab fee schedule,$27.13 ,100% TX Medicaid lab fee schedule,$27.13 ,100% TX Medicaid lab fee schedule,$27.13 ,100% TX Medicaid lab fee schedule,$25.84 ,$145.16 ,$58.40 
Outpatient Medical Services,LAB,84703,"BLOOD TEST, HCG (PREGNANCY TEST)",300,$82.00 ,$69.70 ,85% of total billed charges,$63.14 ,77% of total billed charges,$7.52 ,100% of Medicare outpatient rates,$32.52 ,350% BCBSTX Lab fee schedule,$33.82 ,364% BCBSTX Lab fee schedule,$33.82 ,364% BCBSTX Lab fee schedule,$33.82 ,364% BCBSTX Lab fee schedule,$73.80 ,90% of total billed charges,$65.60 ,80% of total billed charges,$73.80 ,90% of total billed charges,$61.50 ,75% of total billed charges,$9.17 ,100% of Medicare outpatient rates,$9.17 ,100% of Medicare outpatient rates,$9.17 ,100% of Medicare outpatient rates,$6.32 ,100% TX Medicaid lab fee schedule,$7.52 ,100% of Medicare outpatient rates,$54.94 ,67% of total billed charges,$11.17 ,105% of 2012 Medicare outpatient rates,$6.01 ,80% of Medicare outpatient rates,$65.60 ,80% of total billed charges,$53.30 ,65% of total billed charges,$7.77 ,123% TX Medicaid lab fee schedule,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$7.52 ,100% of Medicare outpatient rates,$6.32 ,100% TX Medicaid lab fee schedule,$6.32 ,100% TX Medicaid lab fee schedule,$6.32 ,100% TX Medicaid lab fee schedule,$6.32 ,100% TX Medicaid lab fee schedule,$6.32 ,100% TX Medicaid lab fee schedule,$6.32 ,100% TX Medicaid lab fee schedule,$6.01 ,$73.80 ,$32.80 
Outpatient Medical Services,LAB,85014,"BLOOD TEST, HEMATOCRIT",300,$32.00 ,$27.20 ,85% of total billed charges,$24.64 ,77% of total billed charges,$2.37 ,100% of Medicare outpatient rates,$10.26 ,350% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$28.80 ,90% of total billed charges,$25.60 ,80% of total billed charges,$28.80 ,90% of total billed charges,$24.00 ,75% of total billed charges,$2.89 ,100% of Medicare outpatient rates,$2.89 ,100% of Medicare outpatient rates,$2.89 ,100% of Medicare outpatient rates,$1.99 ,100% TX Medicaid lab fee schedule,$2.37 ,100% of Medicare outpatient rates,$21.44 ,67% of total billed charges,$3.51 ,105% of 2012 Medicare outpatient rates,$1.89 ,80% of Medicare outpatient rates,$25.60 ,80% of total billed charges,$20.80 ,65% of total billed charges,$2.45 ,123% TX Medicaid lab fee schedule,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.89 ,$28.80 ,$12.80 
Outpatient Medical Services,LAB,85018,"BLOOD TEST, HEMOGLOBIN",300,$38.00 ,$32.30 ,85% of total billed charges,$29.26 ,77% of total billed charges,$2.37 ,100% of Medicare outpatient rates,$10.26 ,350% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$10.67 ,364% BCBSTX Lab fee schedule,$34.20 ,90% of total billed charges,$30.40 ,80% of total billed charges,$34.20 ,90% of total billed charges,$28.50 ,75% of total billed charges,$2.89 ,100% of Medicare outpatient rates,$2.89 ,100% of Medicare outpatient rates,$2.89 ,100% of Medicare outpatient rates,$1.99 ,100% TX Medicaid lab fee schedule,$2.37 ,100% of Medicare outpatient rates,$25.46 ,67% of total billed charges,$3.51 ,105% of 2012 Medicare outpatient rates,$1.89 ,80% of Medicare outpatient rates,$30.40 ,80% of total billed charges,$24.70 ,65% of total billed charges,$2.45 ,123% TX Medicaid lab fee schedule,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$2.37 ,100% of Medicare outpatient rates,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.99 ,100% TX Medicaid lab fee schedule,$1.89 ,$34.20 ,$15.20 
Outpatient Medical Services,LAB,84144,"BLOOD TEST, PROGESTERONE",300,$99.00 ,$84.15 ,85% of total billed charges,$76.23 ,77% of total billed charges,$20.86 ,100% of Medicare outpatient rates,$90.16 ,350% BCBSTX Lab fee schedule,$93.77 ,364% BCBSTX Lab fee schedule,$93.77 ,364% BCBSTX Lab fee schedule,$93.77 ,364% BCBSTX Lab fee schedule,$89.10 ,90% of total billed charges,$79.20 ,80% of total billed charges,$89.10 ,90% of total billed charges,$74.25 ,75% of total billed charges,$25.44 ,100% of Medicare outpatient rates,$25.44 ,100% of Medicare outpatient rates,$25.44 ,100% of Medicare outpatient rates,$17.52 ,100% TX Medicaid lab fee schedule,$20.86 ,100% of Medicare outpatient rates,$66.33 ,67% of total billed charges,$31.02 ,105% of 2012 Medicare outpatient rates,$16.68 ,80% of Medicare outpatient rates,$79.20 ,80% of total billed charges,$64.35 ,65% of total billed charges,$21.55 ,123% TX Medicaid lab fee schedule,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$20.86 ,100% of Medicare outpatient rates,$17.52 ,100% TX Medicaid lab fee schedule,$17.52 ,100% TX Medicaid lab fee schedule,$17.52 ,100% TX Medicaid lab fee schedule,$17.52 ,100% TX Medicaid lab fee schedule,$17.52 ,100% TX Medicaid lab fee schedule,$17.52 ,100% TX Medicaid lab fee schedule,$16.68 ,$93.77 ,$39.60 
Outpatient Medical Services,LAB,86304,CA 125 (CANCER ANTIGEN),300,$129.00 ,$109.65 ,85% of total billed charges,$99.33 ,77% of total billed charges,$20.81 ,100% of Medicare outpatient rates,$89.95 ,350% BCBSTX Lab fee schedule,$93.55 ,364% BCBSTX Lab fee schedule,$93.55 ,364% BCBSTX Lab fee schedule,$93.55 ,364% BCBSTX Lab fee schedule,$116.10 ,90% of total billed charges,$103.20 ,80% of total billed charges,$116.10 ,90% of total billed charges,$96.75 ,75% of total billed charges,$25.38 ,100% of Medicare outpatient rates,$25.38 ,100% of Medicare outpatient rates,$25.38 ,100% of Medicare outpatient rates,$17.48 ,100% TX Medicaid lab fee schedule,$20.81 ,100% of Medicare outpatient rates,$86.43 ,67% of total billed charges,$30.95 ,105% of 2012 Medicare outpatient rates,$16.64 ,80% of Medicare outpatient rates,$103.20 ,80% of total billed charges,$83.85 ,65% of total billed charges,$21.50 ,123% TX Medicaid lab fee schedule,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$20.81 ,100% of Medicare outpatient rates,$17.48 ,100% TX Medicaid lab fee schedule,$17.48 ,100% TX Medicaid lab fee schedule,$17.48 ,100% TX Medicaid lab fee schedule,$17.48 ,100% TX Medicaid lab fee schedule,$17.48 ,100% TX Medicaid lab fee schedule,$17.48 ,100% TX Medicaid lab fee schedule,$16.64 ,$116.10 ,$51.60 
Outpatient Medical Services,LAB,82378,CEA (CARCINOEMBRYONIC ANTIGEN),300,$124.00 ,$105.40 ,85% of total billed charges,$95.48 ,77% of total billed charges,$18.96 ,100% of Medicare outpatient rates,$81.94 ,350% BCBSTX Lab fee schedule,$85.21 ,364% BCBSTX Lab fee schedule,$85.21 ,364% BCBSTX Lab fee schedule,$85.21 ,364% BCBSTX Lab fee schedule,$111.60 ,90% of total billed charges,$99.20 ,80% of total billed charges,$111.60 ,90% of total billed charges,$93.00 ,75% of total billed charges,$23.13 ,100% of Medicare outpatient rates,$23.13 ,100% of Medicare outpatient rates,$23.13 ,100% of Medicare outpatient rates,$15.93 ,100% TX Medicaid lab fee schedule,$18.96 ,100% of Medicare outpatient rates,$83.08 ,67% of total billed charges,$28.21 ,105% of 2012 Medicare outpatient rates,$15.16 ,80% of Medicare outpatient rates,$99.20 ,80% of total billed charges,$80.60 ,65% of total billed charges,$19.59 ,123% TX Medicaid lab fee schedule,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$18.96 ,100% of Medicare outpatient rates,$15.93 ,100% TX Medicaid lab fee schedule,$15.93 ,100% TX Medicaid lab fee schedule,$15.93 ,100% TX Medicaid lab fee schedule,$15.93 ,100% TX Medicaid lab fee schedule,$15.93 ,100% TX Medicaid lab fee schedule,$15.93 ,100% TX Medicaid lab fee schedule,$15.16 ,$111.60 ,$49.60 
Outpatient Medical Services,LAB,86769,COVID ANTIBODY TEST,300,$94.00 ,$79.90 ,85% of total billed charges,$72.38 ,77% of total billed charges,$42.13 ,100% of Medicare outpatient rates,$147.46 ,350% BCBSTX Lab fee schedule,$153.35 ,364% BCBSTX Lab fee schedule,$153.35 ,364% BCBSTX Lab fee schedule,$153.35 ,364% BCBSTX Lab fee schedule,$84.60 ,90% of total billed charges,$75.20 ,80% of total billed charges,$84.60 ,90% of total billed charges,$70.50 ,75% of total billed charges,$51.39 ,100% of Medicare outpatient rates,$51.39 ,100% of Medicare outpatient rates,$51.39 ,100% of Medicare outpatient rates,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$42.13 ,100% of Medicare outpatient rates,$62.98 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$33.70 ,80% of Medicare outpatient rates,$75.20 ,80% of total billed charges,$61.10 ,65% of total billed charges,$33.53 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$42.13 ,100% of Medicare outpatient rates,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$27.26 ,$153.35 ,$37.60 
Outpatient Medical Services,LAB,87426,COVID ANTIGEN TEST (RAPID IN HOUSE),300,$79.00 ,$67.15 ,85% of total billed charges,$60.83 ,77% of total billed charges,$35.33 ,100% of Medicare outpatient rates,$158.31 ,350% BCBSTX Lab fee schedule,$164.64 ,364% BCBSTX Lab fee schedule,$164.64 ,364% BCBSTX Lab fee schedule,$164.64 ,364% BCBSTX Lab fee schedule,$71.10 ,90% of total billed charges,$63.20 ,80% of total billed charges,$71.10 ,90% of total billed charges,$59.25 ,75% of total billed charges,$43.10 ,100% of Medicare outpatient rates,$43.10 ,100% of Medicare outpatient rates,$43.10 ,100% of Medicare outpatient rates,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$35.33 ,100% of Medicare outpatient rates,$52.93 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$28.26 ,80% of Medicare outpatient rates,$63.20 ,80% of total billed charges,$51.35 ,65% of total billed charges,$28.18 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$35.33 ,100% of Medicare outpatient rates,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$22.91 ,$164.64 ,$31.60 
Outpatient Medical Services,LAB,87637,COVID COMBO FLU-RSV-COVID,300,$307.00 ,$260.95 ,85% of total billed charges,$236.39 ,77% of total billed charges,$142.63 ,100% of Medicare outpatient rates,$499.21 ,350% BCBSTX Lab fee schedule,$519.17 ,364% BCBSTX Lab fee schedule,$519.17 ,364% BCBSTX Lab fee schedule,$519.17 ,364% BCBSTX Lab fee schedule,$276.30 ,90% of total billed charges,$245.60 ,80% of total billed charges,$276.30 ,90% of total billed charges,$230.25 ,75% of total billed charges,$174.00 ,100% of Medicare outpatient rates,$174.00 ,100% of Medicare outpatient rates,$174.00 ,100% of Medicare outpatient rates,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$142.63 ,100% of Medicare outpatient rates,$205.69 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$114.10 ,80% of Medicare outpatient rates,$245.60 ,80% of total billed charges,$199.55 ,65% of total billed charges,$109.51 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$142.63 ,100% of Medicare outpatient rates,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.03 ,$519.17 ,$122.80 
Outpatient Medical Services,LAB,87635,COVID SENDOUT PCR TEST,300,$90.00 ,$76.50 ,85% of total billed charges,$69.30 ,77% of total billed charges,$51.31 ,100% of Medicare outpatient rates,$179.59 ,350% BCBSTX Lab fee schedule,$186.77 ,364% BCBSTX Lab fee schedule,$186.77 ,364% BCBSTX Lab fee schedule,$186.77 ,364% BCBSTX Lab fee schedule,$81.00 ,90% of total billed charges,$72.00 ,80% of total billed charges,$81.00 ,90% of total billed charges,$67.50 ,75% of total billed charges,$62.59 ,100% of Medicare outpatient rates,$62.59 ,100% of Medicare outpatient rates,$62.59 ,100% of Medicare outpatient rates,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.31 ,100% of Medicare outpatient rates,$60.30 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$41.04 ,80% of Medicare outpatient rates,$72.00 ,80% of total billed charges,$58.50 ,65% of total billed charges,$32.10 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$51.31 ,100% of Medicare outpatient rates,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,$186.77 ,$36.00 
Outpatient Medical Services,LAB,80162,DIGOXIN LEVEL,300,$88.00 ,$74.80 ,85% of total billed charges,$67.76 ,77% of total billed charges,$13.28 ,100% of Medicare outpatient rates,$57.37 ,350% BCBSTX Lab fee schedule,$59.66 ,364% BCBSTX Lab fee schedule,$59.66 ,364% BCBSTX Lab fee schedule,$59.66 ,364% BCBSTX Lab fee schedule,$79.20 ,90% of total billed charges,$70.40 ,80% of total billed charges,$79.20 ,90% of total billed charges,$66.00 ,75% of total billed charges,$16.20 ,100% of Medicare outpatient rates,$16.20 ,100% of Medicare outpatient rates,$16.20 ,100% of Medicare outpatient rates,$11.16 ,100% TX Medicaid lab fee schedule,$13.28 ,100% of Medicare outpatient rates,$58.96 ,67% of total billed charges,$19.74 ,105% of 2012 Medicare outpatient rates,$10.62 ,80% of Medicare outpatient rates,$70.40 ,80% of total billed charges,$57.20 ,65% of total billed charges,$13.73 ,123% TX Medicaid lab fee schedule,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$13.28 ,100% of Medicare outpatient rates,$11.16 ,100% TX Medicaid lab fee schedule,$11.16 ,100% TX Medicaid lab fee schedule,$11.16 ,100% TX Medicaid lab fee schedule,$11.16 ,100% TX Medicaid lab fee schedule,$11.16 ,100% TX Medicaid lab fee schedule,$11.16 ,100% TX Medicaid lab fee schedule,$10.62 ,$79.20 ,$35.20 
Outpatient Medical Services,LAB,82951,GLUCOSE OB TOLERANCE 3 HR,300,$129.00 ,$109.65 ,85% of total billed charges,$99.33 ,77% of total billed charges,$12.87 ,100% of Medicare outpatient rates,$55.62 ,350% BCBSTX Lab fee schedule,$57.84 ,364% BCBSTX Lab fee schedule,$57.84 ,364% BCBSTX Lab fee schedule,$57.84 ,364% BCBSTX Lab fee schedule,$116.10 ,90% of total billed charges,$103.20 ,80% of total billed charges,$116.10 ,90% of total billed charges,$96.75 ,75% of total billed charges,$15.70 ,100% of Medicare outpatient rates,$15.70 ,100% of Medicare outpatient rates,$15.70 ,100% of Medicare outpatient rates,$10.81 ,100% TX Medicaid lab fee schedule,$12.87 ,100% of Medicare outpatient rates,$86.43 ,67% of total billed charges,$19.14 ,105% of 2012 Medicare outpatient rates,$10.29 ,80% of Medicare outpatient rates,$103.20 ,80% of total billed charges,$83.85 ,65% of total billed charges,$13.30 ,123% TX Medicaid lab fee schedule,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$12.87 ,100% of Medicare outpatient rates,$10.81 ,100% TX Medicaid lab fee schedule,$10.81 ,100% TX Medicaid lab fee schedule,$10.81 ,100% TX Medicaid lab fee schedule,$10.81 ,100% TX Medicaid lab fee schedule,$10.81 ,100% TX Medicaid lab fee schedule,$10.81 ,100% TX Medicaid lab fee schedule,$10.29 ,$116.10 ,$51.60 
Outpatient Medical Services,LAB,82952,GLUCOSE TOLERANCE 4 HR,300,$44.00 ,$37.40 ,85% of total billed charges,$33.88 ,77% of total billed charges,$3.92 ,100% of Medicare outpatient rates,$16.94 ,350% BCBSTX Lab fee schedule,$17.62 ,364% BCBSTX Lab fee schedule,$17.62 ,364% BCBSTX Lab fee schedule,$17.62 ,364% BCBSTX Lab fee schedule,$39.60 ,90% of total billed charges,$35.20 ,80% of total billed charges,$39.60 ,90% of total billed charges,$33.00 ,75% of total billed charges,$4.78 ,100% of Medicare outpatient rates,$4.78 ,100% of Medicare outpatient rates,$4.78 ,100% of Medicare outpatient rates,$3.29 ,100% TX Medicaid lab fee schedule,$3.92 ,100% of Medicare outpatient rates,$29.48 ,67% of total billed charges,$4.28 ,105% of 2012 Medicare outpatient rates,$3.13 ,80% of Medicare outpatient rates,$35.20 ,80% of total billed charges,$28.60 ,65% of total billed charges,$4.05 ,123% TX Medicaid lab fee schedule,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.92 ,100% of Medicare outpatient rates,$3.29 ,100% TX Medicaid lab fee schedule,$3.29 ,100% TX Medicaid lab fee schedule,$3.29 ,100% TX Medicaid lab fee schedule,$3.29 ,100% TX Medicaid lab fee schedule,$3.29 ,100% TX Medicaid lab fee schedule,$3.29 ,100% TX Medicaid lab fee schedule,$3.13 ,$39.60 ,$17.60 
Outpatient Medical Services,LAB,80074,HEPATITIS ACUTE PANEL,300,$216.00 ,$183.60 ,85% of total billed charges,$166.32 ,77% of total billed charges,$47.63 ,100% of Medicare outpatient rates,$205.84 ,350% BCBSTX Lab fee schedule,$214.07 ,364% BCBSTX Lab fee schedule,$214.07 ,364% BCBSTX Lab fee schedule,$214.07 ,364% BCBSTX Lab fee schedule,$194.40 ,90% of total billed charges,$172.80 ,80% of total billed charges,$194.40 ,90% of total billed charges,$162.00 ,75% of total billed charges,$58.10 ,100% of Medicare outpatient rates,$58.10 ,100% of Medicare outpatient rates,$58.10 ,100% of Medicare outpatient rates,$40.01 ,100% TX Medicaid lab fee schedule,$47.63 ,100% of Medicare outpatient rates,$144.72 ,67% of total billed charges,$70.84 ,105% of 2012 Medicare outpatient rates,$38.10 ,80% of Medicare outpatient rates,$172.80 ,80% of total billed charges,$140.40 ,65% of total billed charges,$49.21 ,123% TX Medicaid lab fee schedule,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$47.63 ,100% of Medicare outpatient rates,$40.01 ,100% TX Medicaid lab fee schedule,$40.01 ,100% TX Medicaid lab fee schedule,$40.01 ,100% TX Medicaid lab fee schedule,$40.01 ,100% TX Medicaid lab fee schedule,$40.01 ,100% TX Medicaid lab fee schedule,$40.01 ,100% TX Medicaid lab fee schedule,$38.10 ,$214.07 ,$86.40 
Outpatient Medical Services,LAB,80081,OB PANEL WITH HIV,300,$853.00 ,$725.05 ,85% of total billed charges,$656.81 ,77% of total billed charges,$74.86 ,100% of Medicare outpatient rates,$323.47 ,350% BCBSTX Lab fee schedule,$336.41 ,364% BCBSTX Lab fee schedule,$336.41 ,364% BCBSTX Lab fee schedule,$336.41 ,364% BCBSTX Lab fee schedule,$767.70 ,90% of total billed charges,$682.40 ,80% of total billed charges,$767.70 ,90% of total billed charges,$639.75 ,75% of total billed charges,$91.32 ,100% of Medicare outpatient rates,$91.32 ,100% of Medicare outpatient rates,$91.32 ,100% of Medicare outpatient rates,$62.88 ,100% TX Medicaid lab fee schedule,$74.86 ,100% of Medicare outpatient rates,$571.51 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$59.88 ,80% of Medicare outpatient rates,$682.40 ,80% of total billed charges,$554.45 ,65% of total billed charges,$77.34 ,123% TX Medicaid lab fee schedule,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$74.86 ,100% of Medicare outpatient rates,$62.88 ,100% TX Medicaid lab fee schedule,$62.88 ,100% TX Medicaid lab fee schedule,$62.88 ,100% TX Medicaid lab fee schedule,$62.88 ,100% TX Medicaid lab fee schedule,$62.88 ,100% TX Medicaid lab fee schedule,$62.88 ,100% TX Medicaid lab fee schedule,$59.88 ,$767.70 ,$341.20 
Outpatient Medical Services,LAB,80184,PHENOBARBITOL LEVEL,300,$63.00 ,$53.55 ,85% of total billed charges,$48.51 ,77% of total billed charges,$15.30 ,100% of Medicare outpatient rates,$53.55 ,350% BCBSTX Lab fee schedule,$55.69 ,364% BCBSTX Lab fee schedule,$55.69 ,364% BCBSTX Lab fee schedule,$55.69 ,364% BCBSTX Lab fee schedule,$56.70 ,90% of total billed charges,$50.40 ,80% of total billed charges,$56.70 ,90% of total billed charges,$47.25 ,75% of total billed charges,$18.66 ,100% of Medicare outpatient rates,$18.66 ,100% of Medicare outpatient rates,$18.66 ,100% of Medicare outpatient rates,$12.85 ,100% TX Medicaid lab fee schedule,$15.30 ,100% of Medicare outpatient rates,$42.21 ,67% of total billed charges,$17.03 ,105% of 2012 Medicare outpatient rates,$12.24 ,80% of Medicare outpatient rates,$50.40 ,80% of total billed charges,$40.95 ,65% of total billed charges,$15.81 ,123% TX Medicaid lab fee schedule,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$15.30 ,100% of Medicare outpatient rates,$12.85 ,100% TX Medicaid lab fee schedule,$12.85 ,100% TX Medicaid lab fee schedule,$12.85 ,100% TX Medicaid lab fee schedule,$12.85 ,100% TX Medicaid lab fee schedule,$12.85 ,100% TX Medicaid lab fee schedule,$12.85 ,100% TX Medicaid lab fee schedule,$12.24 ,$56.70 ,$25.20 
Outpatient Medical Services,LAB,85049,PLATELET COUNT,300,$31.00 ,$26.35 ,85% of total billed charges,$23.87 ,77% of total billed charges,$4.48 ,100% of Medicare outpatient rates,$19.36 ,350% BCBSTX Lab fee schedule,$20.13 ,364% BCBSTX Lab fee schedule,$20.13 ,364% BCBSTX Lab fee schedule,$20.13 ,364% BCBSTX Lab fee schedule,$27.90 ,90% of total billed charges,$24.80 ,80% of total billed charges,$27.90 ,90% of total billed charges,$23.25 ,75% of total billed charges,$5.46 ,100% of Medicare outpatient rates,$5.46 ,100% of Medicare outpatient rates,$5.46 ,100% of Medicare outpatient rates,$3.76 ,100% TX Medicaid lab fee schedule,$4.48 ,100% of Medicare outpatient rates,$20.77 ,67% of total billed charges,$6.64 ,105% of 2012 Medicare outpatient rates,$3.58 ,80% of Medicare outpatient rates,$24.80 ,80% of total billed charges,$20.15 ,65% of total billed charges,$4.62 ,123% TX Medicaid lab fee schedule,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$4.48 ,100% of Medicare outpatient rates,$3.76 ,100% TX Medicaid lab fee schedule,$3.76 ,100% TX Medicaid lab fee schedule,$3.76 ,100% TX Medicaid lab fee schedule,$3.76 ,100% TX Medicaid lab fee schedule,$3.76 ,100% TX Medicaid lab fee schedule,$3.76 ,100% TX Medicaid lab fee schedule,$3.58 ,$27.90 ,$12.40 
Outpatient Medical Services,LAB,84153,PSA (PROSTATE SPECIFIC ANTIGEN),300,$121.00 ,$102.85 ,85% of total billed charges,$93.17 ,77% of total billed charges,$18.39 ,100% of Medicare outpatient rates,$79.49 ,350% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$108.90 ,90% of total billed charges,$96.80 ,80% of total billed charges,$108.90 ,90% of total billed charges,$90.75 ,75% of total billed charges,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$81.07 ,67% of total billed charges,$27.36 ,105% of 2012 Medicare outpatient rates,$14.71 ,80% of Medicare outpatient rates,$96.80 ,80% of total billed charges,$78.65 ,65% of total billed charges,$19.00 ,123% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$14.71 ,$108.90 ,$48.40 
Outpatient Medical Services,LAB,84154,PSA FREE,300,$174.00 ,$147.90 ,85% of total billed charges,$133.98 ,77% of total billed charges,$18.39 ,100% of Medicare outpatient rates,$79.49 ,350% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$82.66 ,364% BCBSTX Lab fee schedule,$156.60 ,90% of total billed charges,$139.20 ,80% of total billed charges,$156.60 ,90% of total billed charges,$130.50 ,75% of total billed charges,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$22.43 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$116.58 ,67% of total billed charges,$27.36 ,105% of 2012 Medicare outpatient rates,$14.71 ,80% of Medicare outpatient rates,$139.20 ,80% of total billed charges,$113.10 ,65% of total billed charges,$19.00 ,123% TX Medicaid lab fee schedule,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$15.45 ,100% TX Medicaid lab fee schedule,$14.71 ,$156.60 ,$69.60 
Outpatient Medical Services,LAB,84479,T3,300,$48.00 ,$40.80 ,85% of total billed charges,$36.96 ,77% of total billed charges,$6.47 ,100% of Medicare outpatient rates,$27.93 ,350% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$29.05 ,364% BCBSTX Lab fee schedule,$43.20 ,90% of total billed charges,$38.40 ,80% of total billed charges,$43.20 ,90% of total billed charges,$36.00 ,75% of total billed charges,$7.89 ,100% of Medicare outpatient rates,$7.89 ,100% of Medicare outpatient rates,$7.89 ,100% of Medicare outpatient rates,$5.43 ,100% TX Medicaid lab fee schedule,$6.47 ,100% of Medicare outpatient rates,$32.16 ,67% of total billed charges,$9.62 ,105% of 2012 Medicare outpatient rates,$5.17 ,80% of Medicare outpatient rates,$38.40 ,80% of total billed charges,$31.20 ,65% of total billed charges,$6.68 ,123% TX Medicaid lab fee schedule,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$6.47 ,100% of Medicare outpatient rates,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.43 ,100% TX Medicaid lab fee schedule,$5.17 ,$43.20 ,$19.20 
Outpatient Medical Services,LAB,84436,T4 - THYROXINE,300,$48.00 ,$40.80 ,85% of total billed charges,$36.96 ,77% of total billed charges,$6.87 ,100% of Medicare outpatient rates,$29.68 ,350% BCBSTX Lab fee schedule,$30.87 ,364% BCBSTX Lab fee schedule,$30.87 ,364% BCBSTX Lab fee schedule,$30.87 ,364% BCBSTX Lab fee schedule,$43.20 ,90% of total billed charges,$38.40 ,80% of total billed charges,$43.20 ,90% of total billed charges,$36.00 ,75% of total billed charges,$8.38 ,100% of Medicare outpatient rates,$8.38 ,100% of Medicare outpatient rates,$8.38 ,100% of Medicare outpatient rates,$5.77 ,100% TX Medicaid lab fee schedule,$6.87 ,100% of Medicare outpatient rates,$32.16 ,67% of total billed charges,$10.21 ,105% of 2012 Medicare outpatient rates,$5.49 ,80% of Medicare outpatient rates,$38.40 ,80% of total billed charges,$31.20 ,65% of total billed charges,$7.10 ,123% TX Medicaid lab fee schedule,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$6.87 ,100% of Medicare outpatient rates,$5.77 ,100% TX Medicaid lab fee schedule,$5.77 ,100% TX Medicaid lab fee schedule,$5.77 ,100% TX Medicaid lab fee schedule,$5.77 ,100% TX Medicaid lab fee schedule,$5.77 ,100% TX Medicaid lab fee schedule,$5.77 ,100% TX Medicaid lab fee schedule,$5.49 ,$43.20 ,$19.20 
Outpatient Medical Services,LAB,84403,TESTOSTERONE LEVEL,300,$97.00 ,$82.45 ,85% of total billed charges,$74.69 ,77% of total billed charges,$25.81 ,100% of Medicare outpatient rates,$111.55 ,350% BCBSTX Lab fee schedule,$116.01 ,364% BCBSTX Lab fee schedule,$116.01 ,364% BCBSTX Lab fee schedule,$116.01 ,364% BCBSTX Lab fee schedule,$87.30 ,90% of total billed charges,$77.60 ,80% of total billed charges,$87.30 ,90% of total billed charges,$72.75 ,75% of total billed charges,$31.48 ,100% of Medicare outpatient rates,$31.48 ,100% of Medicare outpatient rates,$31.48 ,100% of Medicare outpatient rates,$21.68 ,100% TX Medicaid lab fee schedule,$25.81 ,100% of Medicare outpatient rates,$64.99 ,67% of total billed charges,$38.39 ,105% of 2012 Medicare outpatient rates,$20.64 ,80% of Medicare outpatient rates,$77.60 ,80% of total billed charges,$63.05 ,65% of total billed charges,$26.67 ,123% TX Medicaid lab fee schedule,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$25.81 ,100% of Medicare outpatient rates,$21.68 ,100% TX Medicaid lab fee schedule,$21.68 ,100% TX Medicaid lab fee schedule,$21.68 ,100% TX Medicaid lab fee schedule,$21.68 ,100% TX Medicaid lab fee schedule,$21.68 ,100% TX Medicaid lab fee schedule,$21.68 ,100% TX Medicaid lab fee schedule,$20.64 ,$116.01 ,$38.80 
Outpatient Medical Services,LAB,84478,TRIGLYCERIDES,300,$63.00 ,$53.55 ,85% of total billed charges,$48.51 ,77% of total billed charges,$5.74 ,100% of Medicare outpatient rates,$24.82 ,350% BCBSTX Lab fee schedule,$25.81 ,364% BCBSTX Lab fee schedule,$25.81 ,364% BCBSTX Lab fee schedule,$25.81 ,364% BCBSTX Lab fee schedule,$56.70 ,90% of total billed charges,$50.40 ,80% of total billed charges,$56.70 ,90% of total billed charges,$47.25 ,75% of total billed charges,$7.00 ,100% of Medicare outpatient rates,$7.00 ,100% of Medicare outpatient rates,$7.00 ,100% of Medicare outpatient rates,$4.82 ,100% TX Medicaid lab fee schedule,$5.74 ,100% of Medicare outpatient rates,$42.21 ,67% of total billed charges,$8.55 ,105% of 2012 Medicare outpatient rates,$4.59 ,80% of Medicare outpatient rates,$50.40 ,80% of total billed charges,$40.95 ,65% of total billed charges,$5.93 ,123% TX Medicaid lab fee schedule,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$5.74 ,100% of Medicare outpatient rates,$4.82 ,100% TX Medicaid lab fee schedule,$4.82 ,100% TX Medicaid lab fee schedule,$4.82 ,100% TX Medicaid lab fee schedule,$4.82 ,100% TX Medicaid lab fee schedule,$4.82 ,100% TX Medicaid lab fee schedule,$4.82 ,100% TX Medicaid lab fee schedule,$4.59 ,$56.70 ,$25.20 
Outpatient Medical Services,LAB,81001,URINALYSIS COMPLETE,300,$53.00 ,$45.05 ,85% of total billed charges,$40.81 ,77% of total billed charges,$3.17 ,100% of Medicare outpatient rates,$13.72 ,350% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$14.27 ,364% BCBSTX Lab fee schedule,$47.70 ,90% of total billed charges,$42.40 ,80% of total billed charges,$47.70 ,90% of total billed charges,$39.75 ,75% of total billed charges,$3.86 ,100% of Medicare outpatient rates,$3.86 ,100% of Medicare outpatient rates,$3.86 ,100% of Medicare outpatient rates,$2.66 ,100% TX Medicaid lab fee schedule,$3.17 ,100% of Medicare outpatient rates,$35.51 ,67% of total billed charges,$4.70 ,105% of 2012 Medicare outpatient rates,$2.53 ,80% of Medicare outpatient rates,$42.40 ,80% of total billed charges,$34.45 ,65% of total billed charges,$3.27 ,123% TX Medicaid lab fee schedule,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$3.17 ,100% of Medicare outpatient rates,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.66 ,100% TX Medicaid lab fee schedule,$2.53 ,$47.70 ,$21.20 
Outpatient Medical Services,LAB,81000,URINALYSIS REPEAT SAME DAY,300,$16.00 ,$13.60 ,85% of total billed charges,$12.32 ,77% of total billed charges,$4.01 ,100% of Medicare outpatient rates,$14.07 ,350% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$14.63 ,364% BCBSTX Lab fee schedule,$14.40 ,90% of total billed charges,$12.80 ,80% of total billed charges,$14.40 ,90% of total billed charges,$12.00 ,75% of total billed charges,$4.90 ,100% of Medicare outpatient rates,$4.90 ,100% of Medicare outpatient rates,$4.90 ,100% of Medicare outpatient rates,$3.38 ,100% TX Medicaid lab fee schedule,$4.01 ,100% of Medicare outpatient rates,$10.72 ,67% of total billed charges,$4.70 ,105% of 2012 Medicare outpatient rates,$3.21 ,80% of Medicare outpatient rates,$12.80 ,80% of total billed charges,$10.40 ,65% of total billed charges,$4.16 ,123% TX Medicaid lab fee schedule,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$4.01 ,100% of Medicare outpatient rates,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.38 ,100% TX Medicaid lab fee schedule,$3.21 ,$14.63 ,$6.40 
Outpatient Medical Services,LAB,81002,URINE DIPSTICK GLUCOSE / PROTEIN,300,$20.00 ,$17.00 ,85% of total billed charges,$15.40 ,77% of total billed charges,$3.48 ,100% of Medicare outpatient rates,$12.18 ,350% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$12.67 ,364% BCBSTX Lab fee schedule,$18.00 ,90% of total billed charges,$16.00 ,80% of total billed charges,$18.00 ,90% of total billed charges,$15.00 ,75% of total billed charges,$4.24 ,100% of Medicare outpatient rates,$4.24 ,100% of Medicare outpatient rates,$4.24 ,100% of Medicare outpatient rates,$2.92 ,100% TX Medicaid lab fee schedule,$3.48 ,100% of Medicare outpatient rates,$13.40 ,67% of total billed charges,$3.80 ,105% of 2012 Medicare outpatient rates,$2.78 ,80% of Medicare outpatient rates,$16.00 ,80% of total billed charges,$13.00 ,65% of total billed charges,$3.59 ,123% TX Medicaid lab fee schedule,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$3.48 ,100% of Medicare outpatient rates,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.92 ,100% TX Medicaid lab fee schedule,$2.78 ,$18.00 ,$8.00 
Outpatient Medical Services,LAB,82607,VITAMIN B 12,300,$129.00 ,$109.65 ,85% of total billed charges,$99.33 ,77% of total billed charges,$15.08 ,100% of Medicare outpatient rates,$65.14 ,350% BCBSTX Lab fee schedule,$67.74 ,364% BCBSTX Lab fee schedule,$67.74 ,364% BCBSTX Lab fee schedule,$67.74 ,364% BCBSTX Lab fee schedule,$116.10 ,90% of total billed charges,$103.20 ,80% of total billed charges,$116.10 ,90% of total billed charges,$96.75 ,75% of total billed charges,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$18.39 ,100% of Medicare outpatient rates,$12.67 ,100% TX Medicaid lab fee schedule,$15.08 ,100% of Medicare outpatient rates,$86.43 ,67% of total billed charges,$22.41 ,105% of 2012 Medicare outpatient rates,$12.06 ,80% of Medicare outpatient rates,$103.20 ,80% of total billed charges,$83.85 ,65% of total billed charges,$15.58 ,123% TX Medicaid lab fee schedule,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$15.08 ,100% of Medicare outpatient rates,$12.67 ,100% TX Medicaid lab fee schedule,$12.67 ,100% TX Medicaid lab fee schedule,$12.67 ,100% TX Medicaid lab fee schedule,$12.67 ,100% TX Medicaid lab fee schedule,$12.67 ,100% TX Medicaid lab fee schedule,$12.67 ,100% TX Medicaid lab fee schedule,$12.06 ,$116.10 ,$51.60 
Outpatient Medical Services,LAB,82652,VITAMIN D 1 25 DIHYDROXY,300,$244.00 ,$207.40 ,85% of total billed charges,$187.88 ,77% of total billed charges,$38.50 ,100% of Medicare outpatient rates,$166.36 ,350% BCBSTX Lab fee schedule,$173.01 ,364% BCBSTX Lab fee schedule,$173.01 ,364% BCBSTX Lab fee schedule,$173.01 ,364% BCBSTX Lab fee schedule,$219.60 ,90% of total billed charges,$195.20 ,80% of total billed charges,$219.60 ,90% of total billed charges,$183.00 ,75% of total billed charges,$46.97 ,100% of Medicare outpatient rates,$46.97 ,100% of Medicare outpatient rates,$46.97 ,100% of Medicare outpatient rates,$32.34 ,100% TX Medicaid lab fee schedule,$38.50 ,100% of Medicare outpatient rates,$163.48 ,67% of total billed charges,$57.25 ,105% of 2012 Medicare outpatient rates,$30.80 ,80% of Medicare outpatient rates,$195.20 ,80% of total billed charges,$158.60 ,65% of total billed charges,$39.78 ,123% TX Medicaid lab fee schedule,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$38.50 ,100% of Medicare outpatient rates,$32.34 ,100% TX Medicaid lab fee schedule,$32.34 ,100% TX Medicaid lab fee schedule,$32.34 ,100% TX Medicaid lab fee schedule,$32.34 ,100% TX Medicaid lab fee schedule,$32.34 ,100% TX Medicaid lab fee schedule,$32.34 ,100% TX Medicaid lab fee schedule,$30.80 ,$219.60 ,$97.60 
Outpatient Medical Services,RADIOLOGY,70100,"X-RAY OF MANDIABLE, LESS THAN 4 VIEWS",320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$38.76 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$47.67 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,70110,MANDIBLE COMPLETE MIN 4 VIEWS,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$43.44 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$53.43 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$43.44 ,100% TX Medicaid Rad fee schedule,$43.44 ,100% TX Medicaid Rad fee schedule,$43.44 ,100% TX Medicaid Rad fee schedule,$43.44 ,100% TX Medicaid Rad fee schedule,$43.44 ,100% TX Medicaid Rad fee schedule,$43.44 ,100% TX Medicaid Rad fee schedule,$41.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,70120,MASTOIDS <3 V PER SIDE,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$38.76 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$47.67 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,100% TX Medicaid Rad fee schedule,$38.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,70134,"RADIOLOGIC EXAMINATION,INTERNAL AUDITORY MEATI, COMPLETE",320,"$1,028.00 ",$873.80 ,85% of total billed charges,$791.56 ,77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,$894.39 ,385% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$925.20 ,90% of total billed charges,$822.40 ,80% of total billed charges,$925.20 ,90% of total billed charges,$771.00 ,75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$61.81 ,100% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$688.76 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$369.44 ,80% of Medicare outpatient rates,$822.40 ,80% of total billed charges,$668.20 ,65% of total billed charges,$76.03 ,123% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,100% TX Medicaid Rad fee schedule,$61.81 ,$931.56 ,$411.20 
Outpatient Medical Services,RADIOLOGY,70140,"RADIOLOGIC EXAMINATION,FACIAL BONES; LESS THAN 3 VIEWS",320,$275.00 ,$233.75 ,85% of total billed charges,$211.75 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$247.50 ,90% of total billed charges,$220.00 ,80% of total billed charges,$247.50 ,90% of total billed charges,$206.25 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.25 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.00 ,80% of total billed charges,$178.75 ,65% of total billed charges,$39.86 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,$249.10 ,$110.00 
Outpatient Medical Services,RADIOLOGY,70150,FACIAL BONES MIN 3 V,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$57.95 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$41.76 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,70160,NASAL BONES MIN 3 V,320,$196.00 ,$166.60 ,85% of total billed charges,$150.92 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$176.40 ,90% of total billed charges,$156.80 ,80% of total billed charges,$176.40 ,90% of total billed charges,$147.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$38.43 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$131.32 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$156.80 ,80% of total billed charges,$127.40 ,65% of total billed charges,$47.27 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,100% TX Medicaid Rad fee schedule,$38.43 ,$249.10 ,$78.40 
Outpatient Medical Services,RADIOLOGY,70190,OPTIC FORAMINA XRAY/ORBIT UNIL,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$37.76 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$46.44 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,70200,ORBITS MIN 4 V,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$48.11 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$59.18 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$48.11 ,100% TX Medicaid Rad fee schedule,$48.11 ,100% TX Medicaid Rad fee schedule,$48.11 ,100% TX Medicaid Rad fee schedule,$48.11 ,100% TX Medicaid Rad fee schedule,$48.11 ,100% TX Medicaid Rad fee schedule,$48.11 ,100% TX Medicaid Rad fee schedule,$41.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,70220,SINUS SERIES MIN 3 V XRAY,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$37.76 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$46.44 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,100% TX Medicaid Rad fee schedule,$37.76 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,70240,SELLA TURCICA - XRAY,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$33.08 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$40.69 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,100% TX Medicaid Rad fee schedule,$33.08 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,70250,SKULL - ONE VIEW - XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$36.09 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$44.39 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,100% TX Medicaid Rad fee schedule,$36.09 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,70260,SKULL MINIMUM 4 VIEWS,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$44.78 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$55.08 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,100% TX Medicaid Rad fee schedule,$44.78 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,70328,TEMPEROMANDIBULAR JOINT - XRAY,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$34.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$42.74 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,70360,NECK SOFT TISSUE - XRAY,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$31.74 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$39.04 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,70371,"BARIUM SWALLOW,FOR SPEECH EVAL",320,$381.00 ,$323.85 ,85% of total billed charges,$293.37 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$894.39 ,385% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$342.90 ,90% of total billed charges,$304.80 ,80% of total billed charges,$342.90 ,90% of total billed charges,$285.75 ,75% of total billed charges,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$108.59 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$255.27 ,67% of total billed charges,$82.15 ,105% of 2012 Medicare outpatient rates,$171.47 ,80% of Medicare outpatient rates,$304.80 ,80% of total billed charges,$247.65 ,65% of total billed charges,$133.57 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$108.59 ,100% TX Medicaid Rad fee schedule,$108.59 ,100% TX Medicaid Rad fee schedule,$108.59 ,100% TX Medicaid Rad fee schedule,$108.59 ,100% TX Medicaid Rad fee schedule,$108.59 ,100% TX Medicaid Rad fee schedule,$108.59 ,100% TX Medicaid Rad fee schedule,$82.15 ,$931.56 ,$152.40 
Outpatient Medical Services,RADIOLOGY,71046,CHEST - 2 VIEWS - XRAY,320,$314.00 ,$266.90 ,85% of total billed charges,$241.78 ,77% of total billed charges,$79.73 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$282.60 ,90% of total billed charges,$251.20 ,80% of total billed charges,$282.60 ,90% of total billed charges,$235.50 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$33.75 ,100% TX Medicaid Rad fee schedule,$79.73 ,100% of Medicare outpatient rates,$210.38 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$251.20 ,80% of total billed charges,$204.10 ,65% of total billed charges,$41.51 ,123% TX Medicaid Rad fee schedule,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$79.73 ,100% of Medicare outpatient rates,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,$282.60 ,$125.60 
Outpatient Medical Services,RADIOLOGY,71048,"CHEST,4V,AP,LAT,AP LORDOTIC",320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$46.45 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$57.13 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,100% TX Medicaid Rad fee schedule,$46.45 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,71110,RIBS 3 V BIL XRAY,320,$357.00 ,$303.45 ,85% of total billed charges,$274.89 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$321.30 ,90% of total billed charges,$285.60 ,80% of total billed charges,$321.30 ,90% of total billed charges,$267.75 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$44.10 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$239.19 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$285.60 ,80% of total billed charges,$232.05 ,65% of total billed charges,$54.24 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$44.10 ,100% TX Medicaid Rad fee schedule,$44.10 ,100% TX Medicaid Rad fee schedule,$44.10 ,100% TX Medicaid Rad fee schedule,$44.10 ,100% TX Medicaid Rad fee schedule,$44.10 ,100% TX Medicaid Rad fee schedule,$44.10 ,100% TX Medicaid Rad fee schedule,$41.76 ,$458.98 ,$142.80 
Outpatient Medical Services,RADIOLOGY,71120,STERNUM MIN 2 V XRAY,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$33.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$41.51 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,100% TX Medicaid Rad fee schedule,$33.75 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,71130,STERNOCLAVICULAR JOINT MIN 3 V,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$41.44 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$50.97 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,72040,CERVICAL SPINE 3 VIEWS OR LESS,320,$348.00 ,$295.80 ,85% of total billed charges,$267.96 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$313.20 ,90% of total billed charges,$278.40 ,80% of total billed charges,$313.20 ,90% of total billed charges,$261.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$39.76 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$233.16 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$278.40 ,80% of total billed charges,$226.20 ,65% of total billed charges,$48.90 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,100% TX Medicaid Rad fee schedule,$39.76 ,$313.20 ,$139.20 
Outpatient Medical Services,RADIOLOGY,72050,CERVICAL SPINE 4 OR 5 VIEWS,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$53.46 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$65.76 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,100% TX Medicaid Rad fee schedule,$53.46 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72052,CERVICAL SPINE FLEX & EXT.XRAY,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$62.49 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$76.86 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,100% TX Medicaid Rad fee schedule,$62.49 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72072,THORACIC SPINE 3 VIEWS,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$39.43 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$48.50 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72083,SCOLIOSIS SERIES 2/3 V XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$221.07 ,385% BCBSTX Lowtech Rad fee schedule,$230.25 ,401% BCBSTX Lowtech Rad fee schedule,$230.25 ,401% BCBSTX Lowtech Rad fee schedule,$230.25 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$79.19 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.47 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$97.40 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$79.19 ,100% TX Medicaid Rad fee schedule,$79.19 ,100% TX Medicaid Rad fee schedule,$79.19 ,100% TX Medicaid Rad fee schedule,$79.19 ,100% TX Medicaid Rad fee schedule,$79.19 ,100% TX Medicaid Rad fee schedule,$79.19 ,100% TX Medicaid Rad fee schedule,$78.47 ,$455.40 ,$202.40 
Outpatient Medical Services,RADIOLOGY,72100,LUMBAR SPINE 2V - XRAY,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$40.10 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$49.32 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72110,"X-Ray, lower back, minimum four views",320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$51.45 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$63.28 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,100% TX Medicaid Rad fee schedule,$51.45 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72114,L-SPINE FLEX/EXT COMP MIN 6 VI,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$62.15 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$76.44 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,100% TX Medicaid Rad fee schedule,$62.15 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72120,LUMBAR BENDING FILMS 2 OR 3 V,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$40.76 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$50.13 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,72170,PELVIS - XRAY 1 OR 2 VIEWS,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$28.06 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$34.51 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,100% TX Medicaid Rad fee schedule,$28.06 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72202,SACROILIAC JOINT 3 OR > V XRAY,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$39.43 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$48.50 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,100% TX Medicaid Rad fee schedule,$39.43 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,72220,COCCYX MIN 2 V XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$40.28 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,$455.40 ,$202.40 
Outpatient Medical Services,RADIOLOGY,72265,MYELOGRAM - LUMBAR,320,"$1,273.00 ","$1,082.05 ",85% of total billed charges,$980.21 ,77% of total billed charges,$679.90 ,100% of Medicare outpatient rates,"$2,625.24 ",385% BCBSTX Lowtech Rad fee schedule,"$2,734.34 ",401% BCBSTX Lowtech Rad fee schedule,"$2,734.34 ",401% BCBSTX Lowtech Rad fee schedule,"$2,734.34 ",401% BCBSTX Lowtech Rad fee schedule,"$1,145.70 ",90% of total billed charges,"$1,018.40 ",80% of total billed charges,"$1,145.70 ",90% of total billed charges,$954.75 ,75% of total billed charges,$829.48 ,100% of Medicare outpatient rates,$829.48 ,100% of Medicare outpatient rates,$829.48 ,100% of Medicare outpatient rates,$109.93 ,100% TX Medicaid Rad fee schedule,$679.90 ,100% of Medicare outpatient rates,$852.91 ,67% of total billed charges,$460.81 ,105% of 2012 Medicare outpatient rates,$543.92 ,80% of Medicare outpatient rates,"$1,018.40 ",80% of total billed charges,$827.45 ,65% of total billed charges,$135.21 ,123% TX Medicaid Rad fee schedule,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,100% TX Medicaid Rad fee schedule,$109.93 ,"$2,734.34 ",$509.20 
Outpatient Medical Services,RADIOLOGY,73000,CLAVICLE XRAY,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$39.86 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73010,SCAPULA,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$23.73 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$29.19 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,100% TX Medicaid Rad fee schedule,$23.73 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,73030,SHOULDER MIN 2 V WT BEARING,320,$248.00 ,$210.80 ,85% of total billed charges,$190.96 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$223.20 ,90% of total billed charges,$198.40 ,80% of total billed charges,$223.20 ,90% of total billed charges,$186.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$34.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$166.16 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$198.40 ,80% of total billed charges,$161.20 ,65% of total billed charges,$42.74 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,100% TX Medicaid Rad fee schedule,$34.75 ,$249.10 ,$99.20 
Outpatient Medical Services,RADIOLOGY,73050,SHOULDER-WT.BEARING BILAT.XRAY,320,$364.00 ,$309.40 ,85% of total billed charges,$280.28 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$327.60 ,90% of total billed charges,$291.20 ,80% of total billed charges,$327.60 ,90% of total billed charges,$273.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$28.74 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$243.88 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$291.20 ,80% of total billed charges,$236.60 ,65% of total billed charges,$35.35 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,100% TX Medicaid Rad fee schedule,$28.74 ,$327.60 ,$145.60 
Outpatient Medical Services,RADIOLOGY,73060,HUMERUS MIN 2 V LT,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$39.86 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,100% TX Medicaid Rad fee schedule,$32.41 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73070,"ELBOW 2 VIEWS, LEFT",320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$36.16 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73080,"ELBOW LEFT, 4 VIEWS",320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$40.28 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73090,FOREARM 2 V LT,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$36.16 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73130,HANDS 3 VIEW MIN LEFT,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$45.62 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73140,FINGERS 3V LEFT 2ND DIGIT,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$38.09 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$46.85 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,100% TX Medicaid Rad fee schedule,$38.09 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,73502,HIP 2-3 V,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$57.95 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73522,HIP BILATERAL 3-4 V,320,$364.00 ,$309.40 ,85% of total billed charges,$280.28 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$327.60 ,90% of total billed charges,$291.20 ,80% of total billed charges,$327.60 ,90% of total billed charges,$273.00 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$53.80 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$243.88 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.48 ,80% of Medicare outpatient rates,$291.20 ,80% of total billed charges,$236.60 ,65% of total billed charges,$66.17 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,100% TX Medicaid Rad fee schedule,$53.80 ,$458.98 ,$145.60 
Outpatient Medical Services,RADIOLOGY,73552,FEMUR MIN 2 V LT,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$35.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$43.97 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,100% TX Medicaid Rad fee schedule,$35.75 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73560,KNEE  1-2 VIEWS,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$34.41 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$42.32 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73562,KNEE  3 VIEWS,320,$285.00 ,$242.25 ,85% of total billed charges,$219.45 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$256.50 ,90% of total billed charges,$228.00 ,80% of total billed charges,$256.50 ,90% of total billed charges,$213.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$40.76 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$190.95 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$228.00 ,80% of total billed charges,$185.25 ,65% of total billed charges,$50.13 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,100% TX Medicaid Rad fee schedule,$40.76 ,$256.50 ,$114.00 
Outpatient Medical Services,RADIOLOGY,73564,KNEE LEFT COMPLETE 4 PLUS V,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$46.78 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$57.54 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$46.78 ,100% TX Medicaid Rad fee schedule,$46.78 ,100% TX Medicaid Rad fee schedule,$46.78 ,100% TX Medicaid Rad fee schedule,$46.78 ,100% TX Medicaid Rad fee schedule,$46.78 ,100% TX Medicaid Rad fee schedule,$46.78 ,100% TX Medicaid Rad fee schedule,$41.76 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,73565,KNEE BILAT. WGHT. BEARING XRAY,320,$357.00 ,$303.45 ,85% of total billed charges,$274.89 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$321.30 ,90% of total billed charges,$285.60 ,80% of total billed charges,$321.30 ,90% of total billed charges,$267.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$40.10 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$239.19 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$285.60 ,80% of total billed charges,$232.05 ,65% of total billed charges,$49.32 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,100% TX Medicaid Rad fee schedule,$40.10 ,$321.30 ,$142.80 
Outpatient Medical Services,RADIOLOGY,73590,LOWER LEG -2 V LT XRAY,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$31.74 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$39.04 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,100% TX Medicaid Rad fee schedule,$31.74 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73600,ANKLE LEFT 2 VIEWS,320,$281.00 ,$238.85 ,85% of total billed charges,$216.37 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$252.90 ,90% of total billed charges,$224.80 ,80% of total billed charges,$252.90 ,90% of total billed charges,$210.75 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$188.27 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$224.80 ,80% of total billed charges,$182.65 ,65% of total billed charges,$40.28 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,100% TX Medicaid Rad fee schedule,$32.75 ,$252.90 ,$112.40 
Outpatient Medical Services,RADIOLOGY,73610,ANKLE LEFT 3 VIEWS,320,$348.00 ,$295.80 ,85% of total billed charges,$267.96 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$313.20 ,90% of total billed charges,$278.40 ,80% of total billed charges,$313.20 ,90% of total billed charges,$261.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$233.16 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$278.40 ,80% of total billed charges,$226.20 ,65% of total billed charges,$45.62 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,$313.20 ,$139.20 
Outpatient Medical Services,RADIOLOGY,73630,FOOT - LEFT WEIGHT BEARING 3V,320,$348.00 ,$295.80 ,85% of total billed charges,$267.96 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$313.20 ,90% of total billed charges,$278.40 ,80% of total billed charges,$313.20 ,90% of total billed charges,$261.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$34.41 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$233.16 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$278.40 ,80% of total billed charges,$226.20 ,65% of total billed charges,$42.32 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,100% TX Medicaid Rad fee schedule,$34.41 ,$313.20 ,$139.20 
Outpatient Medical Services,RADIOLOGY,73660,TOES (S) MINIMUM 2 VIEWS,320,$364.00 ,$309.40 ,85% of total billed charges,$280.28 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$327.60 ,90% of total billed charges,$291.20 ,80% of total billed charges,$327.60 ,90% of total billed charges,$273.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$243.88 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$291.20 ,80% of total billed charges,$236.60 ,65% of total billed charges,$36.16 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,100% TX Medicaid Rad fee schedule,$29.40 ,$327.60 ,$145.60 
Outpatient Medical Services,RADIOLOGY,74018,ABDOMEN - UPRIGHT - XRAY,320,$276.00 ,$234.60 ,85% of total billed charges,$212.52 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$248.40 ,90% of total billed charges,$220.80 ,80% of total billed charges,$248.40 ,90% of total billed charges,$207.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$30.08 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$184.92 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$220.80 ,80% of total billed charges,$179.40 ,65% of total billed charges,$37.00 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,100% TX Medicaid Rad fee schedule,$30.08 ,$249.10 ,$110.40 
Outpatient Medical Services,RADIOLOGY,74019,ABDOMEN-LAT. DECUB.BILAT. XRAY,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$45.62 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,100% TX Medicaid Rad fee schedule,$37.09 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,74021,ABDOMEN - MULTIPLE VIEWS XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$43.10 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$53.01 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,100% TX Medicaid Rad fee schedule,$43.10 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,74022,ABDOMEN COMP. ACUTE & PA CHEST,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$50.13 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$61.66 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,100% TX Medicaid Rad fee schedule,$50.13 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,74220,ESOPHAGRAM - XRAY,320,"$1,118.00 ",$950.30 ,85% of total billed charges,$860.86 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,006.20 ",90% of total billed charges,$894.40 ,80% of total billed charges,"$1,006.20 ",90% of total billed charges,$838.50 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$99.90 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$749.06 ,67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$894.40 ,80% of total billed charges,$726.70 ,65% of total billed charges,$122.88 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$99.90 ,100% TX Medicaid Rad fee schedule,$99.90 ,100% TX Medicaid Rad fee schedule,$99.90 ,100% TX Medicaid Rad fee schedule,$99.90 ,100% TX Medicaid Rad fee schedule,$99.90 ,100% TX Medicaid Rad fee schedule,$99.90 ,100% TX Medicaid Rad fee schedule,$80.00 ,"$1,013.49 ",$447.20 
Outpatient Medical Services,RADIOLOGY,74240,UPPER GI SERIES - XRAY,320,"$1,139.00 ",$968.15 ,85% of total billed charges,$877.03 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,025.10 ",90% of total billed charges,$911.20 ,80% of total billed charges,"$1,025.10 ",90% of total billed charges,$854.25 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$124.96 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$763.13 ,67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$911.20 ,80% of total billed charges,$740.35 ,65% of total billed charges,$153.70 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$124.96 ,100% TX Medicaid Rad fee schedule,$124.96 ,100% TX Medicaid Rad fee schedule,$124.96 ,100% TX Medicaid Rad fee schedule,$124.96 ,100% TX Medicaid Rad fee schedule,$124.96 ,100% TX Medicaid Rad fee schedule,$124.96 ,100% TX Medicaid Rad fee schedule,$80.00 ,"$1,025.10 ",$455.60 
Outpatient Medical Services,RADIOLOGY,74246,"UPPER GI, BARIUM SWALLOW",320,"$1,118.00 ",$950.30 ,85% of total billed charges,$860.86 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,006.20 ",90% of total billed charges,$894.40 ,80% of total billed charges,"$1,006.20 ",90% of total billed charges,$838.50 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$141.68 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$749.06 ,67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$894.40 ,80% of total billed charges,$726.70 ,65% of total billed charges,$174.27 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$141.68 ,100% TX Medicaid Rad fee schedule,$141.68 ,100% TX Medicaid Rad fee schedule,$141.68 ,100% TX Medicaid Rad fee schedule,$141.68 ,100% TX Medicaid Rad fee schedule,$141.68 ,100% TX Medicaid Rad fee schedule,$141.68 ,100% TX Medicaid Rad fee schedule,$80.00 ,"$1,013.49 ",$447.20 
Outpatient Medical Services,RADIOLOGY,74250,SMALL BOWEL SERIES - XRAY,320,$537.00 ,$456.45 ,85% of total billed charges,$413.49 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$483.30 ,90% of total billed charges,$429.60 ,80% of total billed charges,$483.30 ,90% of total billed charges,$402.75 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$124.30 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$359.79 ,67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$429.60 ,80% of total billed charges,$349.05 ,65% of total billed charges,$152.89 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$124.30 ,100% TX Medicaid Rad fee schedule,$124.30 ,100% TX Medicaid Rad fee schedule,$124.30 ,100% TX Medicaid Rad fee schedule,$124.30 ,100% TX Medicaid Rad fee schedule,$124.30 ,100% TX Medicaid Rad fee schedule,$124.30 ,100% TX Medicaid Rad fee schedule,$80.00 ,$483.30 ,$214.80 
Outpatient Medical Services,RADIOLOGY,74270,BARIUM ENEMA - XRAY,320,"$1,118.00 ",$950.30 ,85% of total billed charges,$860.86 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,006.20 ",90% of total billed charges,$894.40 ,80% of total billed charges,"$1,006.20 ",90% of total billed charges,$838.50 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$156.04 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$749.06 ,67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$894.40 ,80% of total billed charges,$726.70 ,65% of total billed charges,$191.93 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$156.04 ,100% TX Medicaid Rad fee schedule,$156.04 ,100% TX Medicaid Rad fee schedule,$156.04 ,100% TX Medicaid Rad fee schedule,$156.04 ,100% TX Medicaid Rad fee schedule,$156.04 ,100% TX Medicaid Rad fee schedule,$156.04 ,100% TX Medicaid Rad fee schedule,$80.00 ,"$1,013.49 ",$447.20 
Outpatient Medical Services,RADIOLOGY,74280,BARIUM ENEMA W/AIR CONT. XRAY,320,$745.00 ,$633.25 ,85% of total billed charges,$573.65 ,77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$636.98 ,385% BCBSTX Lowtech Rad fee schedule,$663.45 ,401% BCBSTX Lowtech Rad fee schedule,$663.45 ,401% BCBSTX Lowtech Rad fee schedule,$663.45 ,401% BCBSTX Lowtech Rad fee schedule,$670.50 ,90% of total billed charges,$596.00 ,80% of total billed charges,$670.50 ,90% of total billed charges,$558.75 ,75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$499.15 ,67% of total billed charges,$132.56 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,$596.00 ,80% of total billed charges,$484.25 ,65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.42 ,$670.50 ,$298.00 
Outpatient Medical Services,RADIOLOGY,74290,GALL BLADDER-CHOLSTGRM. XRAY,320,"$2,012.00 ","$1,710.20 ",85% of total billed charges,"$1,549.24 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,810.80 ",90% of total billed charges,"$1,609.60 ",80% of total billed charges,"$1,810.80 ",90% of total billed charges,"$1,509.00 ",75% of total billed charges,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$201.94 ,100% of Medicare outpatient rates,$87.54 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,348.04 ",67% of total billed charges,$80.00 ,105% of 2012 Medicare outpatient rates,$132.42 ,80% of Medicare outpatient rates,"$1,609.60 ",80% of total billed charges,"$1,307.80 ",65% of total billed charges,$107.67 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$87.54 ,100% TX Medicaid Rad fee schedule,$87.54 ,100% TX Medicaid Rad fee schedule,$87.54 ,100% TX Medicaid Rad fee schedule,$87.54 ,100% TX Medicaid Rad fee schedule,$87.54 ,100% TX Medicaid Rad fee schedule,$87.54 ,100% TX Medicaid Rad fee schedule,$80.00 ,"$1,810.80 ",$804.80 
Outpatient Medical Services,RADIOLOGY,74300,CHOLANGIOGRAM - OPERATIVE;XRAY,320,"$2,012.00 ","$1,710.20 ",85% of total billed charges,"$1,549.24 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,$71.84 ,385% BCBSTX Lowtech Rad fee schedule,$74.83 ,401% BCBSTX Lowtech Rad fee schedule,$74.83 ,401% BCBSTX Lowtech Rad fee schedule,$74.83 ,401% BCBSTX Lowtech Rad fee schedule,"$1,810.80 ",90% of total billed charges,"$1,609.60 ",80% of total billed charges,"$1,810.80 ",90% of total billed charges,"$1,509.00 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$1,348.04 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,609.60 ",80% of total billed charges,"$1,307.80 ",65% of total billed charges,$717.68 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$71.84 ,"$1,810.80 ",$804.80 
Outpatient Medical Services,RADIOLOGY,74301,CHOLANGIOGRAM-ADD'L FILMS,320,"$2,012.00 ","$1,710.20 ",85% of total billed charges,"$1,549.24 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,$41.46 ,385% BCBSTX Lowtech Rad fee schedule,$43.19 ,401% BCBSTX Lowtech Rad fee schedule,$43.19 ,401% BCBSTX Lowtech Rad fee schedule,$43.19 ,401% BCBSTX Lowtech Rad fee schedule,"$1,810.80 ",90% of total billed charges,"$1,609.60 ",80% of total billed charges,"$1,810.80 ",90% of total billed charges,"$1,509.00 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$1,348.04 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,609.60 ",80% of total billed charges,"$1,307.80 ",65% of total billed charges,$717.68 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$583.48 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$41.46 ,"$1,810.80 ",$804.80 
Outpatient Medical Services,RADIOLOGY,74400,INTRAVENOUS PYELOGRAM - XRAY,320,"$2,012.00 ","$1,710.20 ",85% of total billed charges,"$1,549.24 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,$331.60 ,385% BCBSTX Lowtech Rad fee schedule,$345.38 ,401% BCBSTX Lowtech Rad fee schedule,$345.38 ,401% BCBSTX Lowtech Rad fee schedule,$345.38 ,401% BCBSTX Lowtech Rad fee schedule,"$1,810.80 ",90% of total billed charges,"$1,609.60 ",80% of total billed charges,"$1,810.80 ",90% of total billed charges,"$1,509.00 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$137.00 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,348.04 ",67% of total billed charges,$171.39 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,609.60 ",80% of total billed charges,"$1,307.80 ",65% of total billed charges,$168.51 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$137.00 ,100% TX Medicaid Rad fee schedule,$137.00 ,100% TX Medicaid Rad fee schedule,$137.00 ,100% TX Medicaid Rad fee schedule,$137.00 ,100% TX Medicaid Rad fee schedule,$137.00 ,100% TX Medicaid Rad fee schedule,$137.00 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,810.80 ",$804.80 
Outpatient Medical Services,RADIOLOGY,74420,RETROGRADE UROGRAPHY - XRAY,320,"$2,012.00 ","$1,710.20 ",85% of total billed charges,"$1,549.24 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,752.02 ",385% BCBSTX Lowtech Rad fee schedule,"$1,824.83 ",401% BCBSTX Lowtech Rad fee schedule,"$1,824.83 ",401% BCBSTX Lowtech Rad fee schedule,"$1,824.83 ",401% BCBSTX Lowtech Rad fee schedule,"$1,810.80 ",90% of total billed charges,"$1,609.60 ",80% of total billed charges,"$1,810.80 ",90% of total billed charges,"$1,509.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$77.19 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$1,348.04 ",67% of total billed charges,$171.39 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$1,609.60 ",80% of total billed charges,"$1,307.80 ",65% of total billed charges,$94.94 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,100% TX Medicaid Rad fee schedule,$77.19 ,"$1,824.83 ",$804.80 
Outpatient Medical Services,RADIOLOGY,74430,CYSTOGRAM XRAY,320,"$1,118.00 ",$950.30 ,85% of total billed charges,$860.86 ,77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,$973.05 ,385% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,013.49 ",401% BCBSTX Lowtech Rad fee schedule,"$1,006.20 ",90% of total billed charges,$894.40 ,80% of total billed charges,"$1,006.20 ",90% of total billed charges,$838.50 ,75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$41.44 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$749.06 ,67% of total billed charges,$171.39 ,105% of 2012 Medicare outpatient rates,$270.53 ,80% of Medicare outpatient rates,$894.40 ,80% of total billed charges,$726.70 ,65% of total billed charges,$50.97 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,100% TX Medicaid Rad fee schedule,$41.44 ,"$1,013.49 ",$447.20 
Outpatient Medical Services,RADIOLOGY,74450,URETHROGRAM - XRAY,320,"$1,028.00 ",$873.80 ,85% of total billed charges,$791.56 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$894.39 ,385% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$925.20 ,90% of total billed charges,$822.40 ,80% of total billed charges,$925.20 ,90% of total billed charges,$771.00 ,75% of total billed charges,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$81.38 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$688.76 ,67% of total billed charges,$171.39 ,105% of 2012 Medicare outpatient rates,$171.47 ,80% of Medicare outpatient rates,$822.40 ,80% of total billed charges,$668.20 ,65% of total billed charges,$100.10 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,100% TX Medicaid Rad fee schedule,$81.38 ,$931.56 ,$411.20 
Outpatient Medical Services,RADIOLOGY,74455,VOIDING CYSTOURETHROGRAM -XRAY,320,"$1,028.00 ",$873.80 ,85% of total billed charges,$791.56 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$894.39 ,385% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$925.20 ,90% of total billed charges,$822.40 ,80% of total billed charges,$925.20 ,90% of total billed charges,$771.00 ,75% of total billed charges,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$261.49 ,100% of Medicare outpatient rates,$105.25 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$688.76 ,67% of total billed charges,$171.39 ,105% of 2012 Medicare outpatient rates,$171.47 ,80% of Medicare outpatient rates,$822.40 ,80% of total billed charges,$668.20 ,65% of total billed charges,$129.46 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,100% TX Medicaid Rad fee schedule,$105.25 ,$931.56 ,$411.20 
Outpatient Medical Services,RADIOLOGY,75820,VENOGRAM LEFT UP/LOW EXTREMITY,320,"$2,702.00 ","$2,296.70 ",85% of total billed charges,"$2,080.54 ",77% of total billed charges,"$1,365.63 ",100% of Medicare outpatient rates,"$2,358.39 ",385% BCBSTX Lowtech Rad fee schedule,"$2,456.41 ",401% BCBSTX Lowtech Rad fee schedule,"$2,456.41 ",401% BCBSTX Lowtech Rad fee schedule,"$2,456.41 ",401% BCBSTX Lowtech Rad fee schedule,"$2,431.80 ",90% of total billed charges,"$2,161.60 ",80% of total billed charges,"$2,431.80 ",90% of total billed charges,"$2,026.50 ",75% of total billed charges,"$1,666.07 ",100% of Medicare outpatient rates,"$1,666.07 ",100% of Medicare outpatient rates,"$1,666.07 ",100% of Medicare outpatient rates,$109.26 ,100% TX Medicaid Rad fee schedule,"$1,365.63 ",100% of Medicare outpatient rates,"$1,810.34 ",67% of total billed charges,$614.75 ,105% of 2012 Medicare outpatient rates,"$1,092.51 ",80% of Medicare outpatient rates,"$2,161.60 ",80% of total billed charges,"$1,756.30 ",65% of total billed charges,$134.39 ,123% TX Medicaid Rad fee schedule,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,100% TX Medicaid Rad fee schedule,$109.26 ,"$2,456.41 ","$1,080.80 "
Outpatient Medical Services,RADIOLOGY,75822,VENOGRAM - BILATERAL - XRAY,320,"$2,484.00 ","$2,111.40 ",85% of total billed charges,"$1,912.68 ",77% of total billed charges,"$1,365.63 ",100% of Medicare outpatient rates,"$3,784.43 ",385% BCBSTX Lowtech Rad fee schedule,"$3,941.71 ",401% BCBSTX Lowtech Rad fee schedule,"$3,941.71 ",401% BCBSTX Lowtech Rad fee schedule,"$3,941.71 ",401% BCBSTX Lowtech Rad fee schedule,"$2,235.60 ",90% of total billed charges,"$1,987.20 ",80% of total billed charges,"$2,235.60 ",90% of total billed charges,"$1,863.00 ",75% of total billed charges,"$1,666.07 ",100% of Medicare outpatient rates,"$1,666.07 ",100% of Medicare outpatient rates,"$1,666.07 ",100% of Medicare outpatient rates,$132.99 ,100% TX Medicaid Rad fee schedule,"$1,365.63 ",100% of Medicare outpatient rates,"$1,664.28 ",67% of total billed charges,$614.75 ,105% of 2012 Medicare outpatient rates,"$1,092.51 ",80% of Medicare outpatient rates,"$1,987.20 ",80% of total billed charges,"$1,614.60 ",65% of total billed charges,$163.58 ,123% TX Medicaid Rad fee schedule,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,"$1,365.63 ",100% of Medicare outpatient rates,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,100% TX Medicaid Rad fee schedule,$132.99 ,"$3,941.71 ",$993.60 
Outpatient Medical Services,RADIOLOGY,76080,FISTULAGRAM - XRAY,320,"$1,028.00 ",$873.80 ,85% of total billed charges,$791.56 ,77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,$894.39 ,385% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$931.56 ,401% BCBSTX Lowtech Rad fee schedule,$925.20 ,90% of total billed charges,$822.40 ,80% of total billed charges,$925.20 ,90% of total billed charges,$771.00 ,75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$60.14 ,100% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$688.76 ,67% of total billed charges,$220.39 ,105% of 2012 Medicare outpatient rates,$369.44 ,80% of Medicare outpatient rates,$822.40 ,80% of total billed charges,$668.20 ,65% of total billed charges,$73.97 ,123% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,100% TX Medicaid Rad fee schedule,$60.14 ,$931.56 ,$411.20 
Outpatient Medical Services,RADIOLOGY,76098,SURGICAL SPECIMEN - X-RAY,320,"$2,191.00 ","$1,862.35 ",85% of total billed charges,"$1,687.07 ",77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,"$1,873.76 ",385% BCBSTX Lowtech Rad fee schedule,"$1,951.63 ",401% BCBSTX Lowtech Rad fee schedule,"$1,951.63 ",401% BCBSTX Lowtech Rad fee schedule,"$1,951.63 ",401% BCBSTX Lowtech Rad fee schedule,"$1,971.90 ",90% of total billed charges,"$1,752.80 ",80% of total billed charges,"$1,971.90 ",90% of total billed charges,"$1,643.25 ",75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$42.10 ,100% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,"$1,467.97 ",67% of total billed charges,$396.22 ,105% of 2012 Medicare outpatient rates,$369.44 ,80% of Medicare outpatient rates,"$1,752.80 ",80% of total billed charges,"$1,424.15 ",65% of total billed charges,$51.78 ,123% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,100% TX Medicaid Rad fee schedule,$42.10 ,"$1,971.90 ",$876.40 
Outpatient Medical Services,RADIOLOGY,76100,SINGLE VIEW BODY PART - XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$90.21 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$110.96 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$90.21 ,100% TX Medicaid Rad fee schedule,$90.21 ,100% TX Medicaid Rad fee schedule,$90.21 ,100% TX Medicaid Rad fee schedule,$90.21 ,100% TX Medicaid Rad fee schedule,$90.21 ,100% TX Medicaid Rad fee schedule,$90.21 ,100% TX Medicaid Rad fee schedule,$70.34 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,76496,ESOPHAGUS FLOUROSCOPY - XRAY,320,$352.00 ,$299.20 ,85% of total billed charges,$271.04 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$316.80 ,90% of total billed charges,$281.60 ,80% of total billed charges,$316.80 ,90% of total billed charges,$264.00 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$80.90 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$235.84 ,67% of total billed charges,$82.15 ,105% of 2012 Medicare outpatient rates,$63.79 ,80% of Medicare outpatient rates,$281.60 ,80% of total billed charges,$228.80 ,65% of total billed charges,$99.51 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$80.90 ,100% TX Medicaid Rad fee schedule,$80.90 ,100% TX Medicaid Rad fee schedule,$80.90 ,100% TX Medicaid Rad fee schedule,$80.90 ,100% TX Medicaid Rad fee schedule,$80.90 ,100% TX Medicaid Rad fee schedule,$80.90 ,100% TX Medicaid Rad fee schedule,$63.79 ,$316.80 ,$140.80 
Outpatient Medical Services,RADIOLOGY,77002,JOINT INJECTION (RADIOLOGY),320,$592.00 ,$503.20 ,85% of total billed charges,$455.84 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$258.37 ,385% BCBSTX Lowtech Rad fee schedule,$269.11 ,401% BCBSTX Lowtech Rad fee schedule,$269.11 ,401% BCBSTX Lowtech Rad fee schedule,$269.11 ,401% BCBSTX Lowtech Rad fee schedule,$532.80 ,90% of total billed charges,$473.60 ,80% of total billed charges,$532.80 ,90% of total billed charges,$444.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$396.64 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$473.60 ,80% of total billed charges,$384.80 ,65% of total billed charges,$211.17 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.68 ,$532.80 ,$236.80 
Outpatient Medical Services,RADIOLOGY,77072,BONE AGE STUDIES - XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$26.06 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$32.05 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,100% TX Medicaid Rad fee schedule,$26.06 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,77073,BONE LENGTH STUDY(LG.LEN.)XRAY,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$45.11 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$55.49 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$45.11 ,100% TX Medicaid Rad fee schedule,$45.11 ,100% TX Medicaid Rad fee schedule,$45.11 ,100% TX Medicaid Rad fee schedule,$45.11 ,100% TX Medicaid Rad fee schedule,$45.11 ,100% TX Medicaid Rad fee schedule,$45.11 ,100% TX Medicaid Rad fee schedule,$41.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,77075,OSSEOUS BONE SURVEY COMPLETE,320,$515.00 ,$437.75 ,85% of total billed charges,$396.55 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$463.50 ,90% of total billed charges,$412.00 ,80% of total billed charges,$463.50 ,90% of total billed charges,$386.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$100.24 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$345.05 ,67% of total billed charges,$70.34 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$412.00 ,80% of total billed charges,$334.75 ,65% of total billed charges,$123.30 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$100.24 ,100% TX Medicaid Rad fee schedule,$100.24 ,100% TX Medicaid Rad fee schedule,$100.24 ,100% TX Medicaid Rad fee schedule,$100.24 ,100% TX Medicaid Rad fee schedule,$100.24 ,100% TX Medicaid Rad fee schedule,$100.24 ,100% TX Medicaid Rad fee schedule,$70.34 ,$463.50 ,$206.00 
Outpatient Medical Services,RADIOLOGY,77077,JOINT SURVEY 2+ JOINTS 1 VIEW,320,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,$41.76 ,105% of 2012 Medicare outpatient rates,$78.48 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$57.95 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$47.11 ,100% TX Medicaid Rad fee schedule,$41.76 ,$458.98 ,$202.40 
Outpatient Medical Services,RADIOLOGY,78740,CYSTOGRAM,320,$952.00 ,$809.20 ,85% of total billed charges,$733.04 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$775.16 ,385% BCBSTX Lowtech Rad fee schedule,$807.37 ,401% BCBSTX Lowtech Rad fee schedule,$807.37 ,401% BCBSTX Lowtech Rad fee schedule,$807.37 ,401% BCBSTX Lowtech Rad fee schedule,$856.80 ,90% of total billed charges,$761.60 ,80% of total billed charges,$856.80 ,90% of total billed charges,$714.00 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$216.85 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$637.84 ,67% of total billed charges,$297.04 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$761.60 ,80% of total billed charges,$618.80 ,65% of total billed charges,$266.73 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,100% TX Medicaid Rad fee schedule,$216.85 ,$856.80 ,$380.80 
Outpatient Medical Services,RADIOLOGY,71047,CHEST W/ LORDOTIC VIEW - XRAY,324,$506.00 ,$430.10 ,85% of total billed charges,$389.62 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$455.40 ,90% of total billed charges,$404.80 ,80% of total billed charges,$455.40 ,90% of total billed charges,$379.50 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$42.44 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$339.02 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$404.80 ,80% of total billed charges,$328.90 ,65% of total billed charges,$52.20 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,100% TX Medicaid Rad fee schedule,$42.44 ,$455.40 ,$202.40 
Outpatient Medical Services,RADIOLOGY,78070,NM PARATHYROID,340,"$1,350.00 ","$1,147.50 ",85% of total billed charges,"$1,039.50 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,062.52 ",385% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,215.00 ",90% of total billed charges,"$1,080.00 ",80% of total billed charges,"$1,215.00 ",90% of total billed charges,"$1,012.50 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$290.03 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$904.50 ,67% of total billed charges,$206.11 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,080.00 ",80% of total billed charges,$877.50 ,65% of total billed charges,$356.74 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$290.03 ,100% TX Medicaid Rad fee schedule,$290.03 ,100% TX Medicaid Rad fee schedule,$290.03 ,100% TX Medicaid Rad fee schedule,$290.03 ,100% TX Medicaid Rad fee schedule,$290.03 ,100% TX Medicaid Rad fee schedule,$290.03 ,100% TX Medicaid Rad fee schedule,$206.11 ,"$1,215.00 ",$540.00 
Outpatient Medical Services,RADIOLOGY,78201,NM LIVER SCAN,340,$872.00 ,$741.20 ,85% of total billed charges,$671.44 ,77% of total billed charges,$463.06 ,100% of Medicare outpatient rates,$683.95 ,385% BCBSTX Lowtech Rad fee schedule,$712.38 ,401% BCBSTX Lowtech Rad fee schedule,$712.38 ,401% BCBSTX Lowtech Rad fee schedule,$712.38 ,401% BCBSTX Lowtech Rad fee schedule,$784.80 ,90% of total billed charges,$697.60 ,80% of total billed charges,$784.80 ,90% of total billed charges,$654.00 ,75% of total billed charges,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$187.45 ,100% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$584.24 ,67% of total billed charges,$273.45 ,105% of 2012 Medicare outpatient rates,$370.44 ,80% of Medicare outpatient rates,$697.60 ,80% of total billed charges,$566.80 ,65% of total billed charges,$230.56 ,123% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,100% TX Medicaid Rad fee schedule,$187.45 ,$784.80 ,$348.80 
Outpatient Medical Services,RADIOLOGY,78202,NM LIVER/SPLEEN VAS FLOW,340,"$1,544.00 ","$1,312.40 ",85% of total billed charges,"$1,188.88 ",77% of total billed charges,$463.06 ,100% of Medicare outpatient rates,$715.72 ,385% BCBSTX Lowtech Rad fee schedule,$745.46 ,401% BCBSTX Lowtech Rad fee schedule,$745.46 ,401% BCBSTX Lowtech Rad fee schedule,$745.46 ,401% BCBSTX Lowtech Rad fee schedule,"$1,389.60 ",90% of total billed charges,"$1,235.20 ",80% of total billed charges,"$1,389.60 ",90% of total billed charges,"$1,158.00 ",75% of total billed charges,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$205.83 ,100% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,"$1,034.48 ",67% of total billed charges,$273.45 ,105% of 2012 Medicare outpatient rates,$370.44 ,80% of Medicare outpatient rates,"$1,235.20 ",80% of total billed charges,"$1,003.60 ",65% of total billed charges,$253.17 ,123% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,100% TX Medicaid Rad fee schedule,$205.83 ,"$1,389.60 ",$617.60 
Outpatient Medical Services,RADIOLOGY,78227,NM HEPATOBILIARY - GB/HIDA,340,"$1,922.00 ","$1,633.70 ",85% of total billed charges,"$1,479.94 ",77% of total billed charges,$463.06 ,100% of Medicare outpatient rates,"$1,642.87 ",385% BCBSTX Lowtech Rad fee schedule,"$1,711.15 ",401% BCBSTX Lowtech Rad fee schedule,"$1,711.15 ",401% BCBSTX Lowtech Rad fee schedule,"$1,711.15 ",401% BCBSTX Lowtech Rad fee schedule,"$1,729.80 ",90% of total billed charges,"$1,537.60 ",80% of total billed charges,"$1,729.80 ",90% of total billed charges,"$1,441.50 ",75% of total billed charges,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$433.04 ,100% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,"$1,287.74 ",67% of total billed charges,$273.45 ,105% of 2012 Medicare outpatient rates,$370.44 ,80% of Medicare outpatient rates,"$1,537.60 ",80% of total billed charges,"$1,249.30 ",65% of total billed charges,$532.64 ,123% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$433.04 ,100% TX Medicaid Rad fee schedule,$433.04 ,100% TX Medicaid Rad fee schedule,$433.04 ,100% TX Medicaid Rad fee schedule,$433.04 ,100% TX Medicaid Rad fee schedule,$433.04 ,100% TX Medicaid Rad fee schedule,$433.04 ,100% TX Medicaid Rad fee schedule,$273.45 ,"$1,729.80 ",$768.80 
Outpatient Medical Services,RADIOLOGY,78264,NM GASTRIC EMPTYING,340,"$1,389.00 ","$1,180.65 ",85% of total billed charges,"$1,069.53 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,209.02 ",385% BCBSTX Lowtech Rad fee schedule,"$1,259.26 ",401% BCBSTX Lowtech Rad fee schedule,"$1,259.26 ",401% BCBSTX Lowtech Rad fee schedule,"$1,259.26 ",401% BCBSTX Lowtech Rad fee schedule,"$1,250.10 ",90% of total billed charges,"$1,111.20 ",80% of total billed charges,"$1,250.10 ",90% of total billed charges,"$1,041.75 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$326.45 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$930.63 ,67% of total billed charges,$227.14 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,111.20 ",80% of total billed charges,$902.85 ,65% of total billed charges,$401.53 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$326.45 ,100% TX Medicaid Rad fee schedule,$326.45 ,100% TX Medicaid Rad fee schedule,$326.45 ,100% TX Medicaid Rad fee schedule,$326.45 ,100% TX Medicaid Rad fee schedule,$326.45 ,100% TX Medicaid Rad fee schedule,$326.45 ,100% TX Medicaid Rad fee schedule,$227.14 ,"$1,259.26 ",$555.60 
Outpatient Medical Services,RADIOLOGY,78265,NM GASTRIC EMPTYING W/SM BOWEL,340,"$1,541.00 ","$1,309.85 ",85% of total billed charges,"$1,186.57 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,341.65 ",385% BCBSTX Lowtech Rad fee schedule,"$1,397.40 ",401% BCBSTX Lowtech Rad fee schedule,"$1,397.40 ",401% BCBSTX Lowtech Rad fee schedule,"$1,397.40 ",401% BCBSTX Lowtech Rad fee schedule,"$1,386.90 ",90% of total billed charges,"$1,232.80 ",80% of total billed charges,"$1,386.90 ",90% of total billed charges,"$1,155.75 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$377.12 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,"$1,032.47 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$285.39 ,80% of Medicare outpatient rates,"$1,232.80 ",80% of total billed charges,"$1,001.65 ",65% of total billed charges,$463.86 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$377.12 ,100% TX Medicaid Rad fee schedule,$377.12 ,100% TX Medicaid Rad fee schedule,$377.12 ,100% TX Medicaid Rad fee schedule,$377.12 ,100% TX Medicaid Rad fee schedule,$377.12 ,100% TX Medicaid Rad fee schedule,$377.12 ,100% TX Medicaid Rad fee schedule,$285.39 ,"$1,397.40 ",$616.40 
Outpatient Medical Services,RADIOLOGY,78278,GI BLEED (TAGGED RBC),340,"$1,413.00 ","$1,201.05 ",85% of total billed charges,"$1,088.01 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,221.45 ",385% BCBSTX Lowtech Rad fee schedule,"$1,272.21 ",401% BCBSTX Lowtech Rad fee schedule,"$1,272.21 ",401% BCBSTX Lowtech Rad fee schedule,"$1,272.21 ",401% BCBSTX Lowtech Rad fee schedule,"$1,271.70 ",90% of total billed charges,"$1,130.40 ",80% of total billed charges,"$1,271.70 ",90% of total billed charges,"$1,059.75 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$342.15 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$946.71 ,67% of total billed charges,$227.14 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,130.40 ",80% of total billed charges,$918.45 ,65% of total billed charges,$420.84 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$342.15 ,100% TX Medicaid Rad fee schedule,$342.15 ,100% TX Medicaid Rad fee schedule,$342.15 ,100% TX Medicaid Rad fee schedule,$342.15 ,100% TX Medicaid Rad fee schedule,$342.15 ,100% TX Medicaid Rad fee schedule,$342.15 ,100% TX Medicaid Rad fee schedule,$227.14 ,"$1,272.21 ",$565.20 
Outpatient Medical Services,RADIOLOGY,78290,NM MECKEL'S DIVERTICULUM,340,"$1,391.00 ","$1,182.35 ",85% of total billed charges,"$1,071.07 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,210.40 ",385% BCBSTX Lowtech Rad fee schedule,"$1,260.70 ",401% BCBSTX Lowtech Rad fee schedule,"$1,260.70 ",401% BCBSTX Lowtech Rad fee schedule,"$1,260.70 ",401% BCBSTX Lowtech Rad fee schedule,"$1,251.90 ",90% of total billed charges,"$1,112.80 ",80% of total billed charges,"$1,251.90 ",90% of total billed charges,"$1,043.25 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$324.78 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$931.97 ,67% of total billed charges,$227.14 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,112.80 ",80% of total billed charges,$904.15 ,65% of total billed charges,$399.48 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$324.78 ,100% TX Medicaid Rad fee schedule,$324.78 ,100% TX Medicaid Rad fee schedule,$324.78 ,100% TX Medicaid Rad fee schedule,$324.78 ,100% TX Medicaid Rad fee schedule,$324.78 ,100% TX Medicaid Rad fee schedule,$324.78 ,100% TX Medicaid Rad fee schedule,$227.14 ,"$1,260.70 ",$556.40 
Outpatient Medical Services,RADIOLOGY,78305,NM BONE SCAN MULTIPLE AREAS,340,"$1,123.00 ",$954.55 ,85% of total billed charges,$864.71 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$978.25 ,385% BCBSTX Lowtech Rad fee schedule,"$1,018.90 ",401% BCBSTX Lowtech Rad fee schedule,"$1,018.90 ",401% BCBSTX Lowtech Rad fee schedule,"$1,018.90 ",401% BCBSTX Lowtech Rad fee schedule,"$1,010.70 ",90% of total billed charges,$898.40 ,80% of total billed charges,"$1,010.70 ",90% of total billed charges,$842.25 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$273.33 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$752.41 ,67% of total billed charges,$230.19 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$898.40 ,80% of total billed charges,$729.95 ,65% of total billed charges,$336.20 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$273.33 ,100% TX Medicaid Rad fee schedule,$273.33 ,100% TX Medicaid Rad fee schedule,$273.33 ,100% TX Medicaid Rad fee schedule,$273.33 ,100% TX Medicaid Rad fee schedule,$273.33 ,100% TX Medicaid Rad fee schedule,$273.33 ,100% TX Medicaid Rad fee schedule,$230.19 ,"$1,018.90 ",$449.20 
Outpatient Medical Services,RADIOLOGY,78306,NM WHOLE BODY BONE SCAN,340,"$1,619.00 ","$1,376.15 ",85% of total billed charges,"$1,246.63 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,062.52 ",385% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,106.68 ",401% BCBSTX Lowtech Rad fee schedule,"$1,457.10 ",90% of total billed charges,"$1,295.20 ",80% of total billed charges,"$1,457.10 ",90% of total billed charges,"$1,214.25 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$294.04 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,"$1,084.73 ",67% of total billed charges,$230.19 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,295.20 ",80% of total billed charges,"$1,052.35 ",65% of total billed charges,$361.67 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$294.04 ,100% TX Medicaid Rad fee schedule,$294.04 ,100% TX Medicaid Rad fee schedule,$294.04 ,100% TX Medicaid Rad fee schedule,$294.04 ,100% TX Medicaid Rad fee schedule,$294.04 ,100% TX Medicaid Rad fee schedule,$294.04 ,100% TX Medicaid Rad fee schedule,$230.19 ,"$1,457.10 ",$647.60 
Outpatient Medical Services,RADIOLOGY,78315,NM BONE SCAN THREE PHASE,340,"$1,534.00 ","$1,303.90 ",85% of total billed charges,"$1,181.18 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,"$1,206.24 ",385% BCBSTX Lowtech Rad fee schedule,"$1,256.37 ",401% BCBSTX Lowtech Rad fee schedule,"$1,256.37 ",401% BCBSTX Lowtech Rad fee schedule,"$1,256.37 ",401% BCBSTX Lowtech Rad fee schedule,"$1,380.60 ",90% of total billed charges,"$1,227.20 ",80% of total billed charges,"$1,380.60 ",90% of total billed charges,"$1,150.50 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$340.15 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,"$1,027.78 ",67% of total billed charges,$230.19 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,227.20 ",80% of total billed charges,$997.10 ,65% of total billed charges,$418.38 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$340.15 ,100% TX Medicaid Rad fee schedule,$340.15 ,100% TX Medicaid Rad fee schedule,$340.15 ,100% TX Medicaid Rad fee schedule,$340.15 ,100% TX Medicaid Rad fee schedule,$340.15 ,100% TX Medicaid Rad fee schedule,$340.15 ,100% TX Medicaid Rad fee schedule,$230.19 ,"$1,380.60 ",$613.60 
Outpatient Medical Services,RADIOLOGY,78452,NM MYOCARDIAL PERFUSION W/SPEC,340,"$3,951.00 ","$3,358.35 ",85% of total billed charges,"$3,042.27 ",77% of total billed charges,"$1,218.24 ",100% of Medicare outpatient rates,"$2,065.41 ",494% BCBSTX Hitech Rad fee schedule,"$2,153.22 ",515% BCBSTX Hitech Rad fee schedule,"$2,153.22 ",515% BCBSTX Hitech Rad fee schedule,"$2,153.22 ",515% BCBSTX Hitech Rad fee schedule,"$3,555.90 ",90% of total billed charges,"$3,160.80 ",80% of total billed charges,"$3,555.90 ",90% of total billed charges,"$2,963.25 ",75% of total billed charges,"$1,486.25 ",100% of Medicare outpatient rates,"$1,486.25 ",100% of Medicare outpatient rates,"$1,486.25 ",100% of Medicare outpatient rates,$465.78 ,100% TX Medicaid Rad fee schedule,"$1,218.24 ",100% of Medicare outpatient rates,"$2,647.17 ",67% of total billed charges,$626.87 ,105% of 2012 Medicare outpatient rates,$974.59 ,80% of Medicare outpatient rates,"$3,160.80 ",80% of total billed charges,"$2,568.15 ",65% of total billed charges,$572.91 ,123% TX Medicaid Rad fee schedule,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,100% TX Medicaid Rad fee schedule,$465.78 ,"$3,555.90 ","$1,580.40 "
Outpatient Medical Services,RADIOLOGY,78466,MYOCARDIAL-S-PLANAR TC,340,"$1,000.00 ",$850.00 ,85% of total billed charges,$770.00 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$847.46 ,494% BCBSTX Hitech Rad fee schedule,$883.48 ,515% BCBSTX Hitech Rad fee schedule,$883.48 ,515% BCBSTX Hitech Rad fee schedule,$883.48 ,515% BCBSTX Hitech Rad fee schedule,$900.00 ,90% of total billed charges,$800.00 ,80% of total billed charges,$900.00 ,90% of total billed charges,$750.00 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$194.46 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$670.00 ,67% of total billed charges,$277.39 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$800.00 ,80% of total billed charges,$650.00 ,65% of total billed charges,$239.19 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,100% TX Medicaid Rad fee schedule,$194.46 ,$900.00 ,$400.00 
Outpatient Medical Services,RADIOLOGY,78468,NM GATED HEART WITH 1 PASS,340,$973.00 ,$827.05 ,85% of total billed charges,$749.21 ,77% of total billed charges,$463.06 ,100% of Medicare outpatient rates,$804.87 ,494% BCBSTX Hitech Rad fee schedule,$839.09 ,515% BCBSTX Hitech Rad fee schedule,$839.09 ,515% BCBSTX Hitech Rad fee schedule,$839.09 ,515% BCBSTX Hitech Rad fee schedule,$875.70 ,90% of total billed charges,$778.40 ,80% of total billed charges,$875.70 ,90% of total billed charges,$729.75 ,75% of total billed charges,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$194.13 ,100% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$651.91 ,67% of total billed charges,$277.39 ,105% of 2012 Medicare outpatient rates,$370.44 ,80% of Medicare outpatient rates,$778.40 ,80% of total billed charges,$632.45 ,65% of total billed charges,$238.78 ,123% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,100% TX Medicaid Rad fee schedule,$194.13 ,$875.70 ,$389.20 
Outpatient Medical Services,RADIOLOGY,78579,NM LUNG SCAN VENTILATION GAS,340,"$1,109.00 ",$942.65 ,85% of total billed charges,$853.93 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$663.24 ,385% BCBSTX Lowtech Rad fee schedule,$690.80 ,401% BCBSTX Lowtech Rad fee schedule,$690.80 ,401% BCBSTX Lowtech Rad fee schedule,$690.80 ,401% BCBSTX Lowtech Rad fee schedule,$998.10 ,90% of total billed charges,$887.20 ,80% of total billed charges,$998.10 ,90% of total billed charges,$831.75 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$183.78 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$743.03 ,67% of total billed charges,$188.69 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$887.20 ,80% of total billed charges,$720.85 ,65% of total billed charges,$226.05 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,100% TX Medicaid Rad fee schedule,$183.78 ,$998.10 ,$443.60 
Outpatient Medical Services,RADIOLOGY,78580,NM LUNG SCAN - PERFUSION ONLY,340,"$1,130.00 ",$960.50 ,85% of total billed charges,$870.10 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$823.52 ,385% BCBSTX Lowtech Rad fee schedule,$857.74 ,401% BCBSTX Lowtech Rad fee schedule,$857.74 ,401% BCBSTX Lowtech Rad fee schedule,$857.74 ,401% BCBSTX Lowtech Rad fee schedule,"$1,017.00 ",90% of total billed charges,$904.00 ,80% of total billed charges,"$1,017.00 ",90% of total billed charges,$847.50 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$232.55 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$757.10 ,67% of total billed charges,$188.69 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$904.00 ,80% of total billed charges,$734.50 ,65% of total billed charges,$286.04 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$232.55 ,100% TX Medicaid Rad fee schedule,$232.55 ,100% TX Medicaid Rad fee schedule,$232.55 ,100% TX Medicaid Rad fee schedule,$232.55 ,100% TX Medicaid Rad fee schedule,$232.55 ,100% TX Medicaid Rad fee schedule,$232.55 ,100% TX Medicaid Rad fee schedule,$188.69 ,"$1,017.00 ",$452.00 
Outpatient Medical Services,RADIOLOGY,78598,NM LUNG VQ SCAN,340,"$1,516.00 ","$1,288.60 ",85% of total billed charges,"$1,167.32 ",77% of total billed charges,$463.06 ,100% of Medicare outpatient rates,"$1,073.61 ",385% BCBSTX Lowtech Rad fee schedule,"$1,118.23 ",401% BCBSTX Lowtech Rad fee schedule,"$1,118.23 ",401% BCBSTX Lowtech Rad fee schedule,"$1,118.23 ",401% BCBSTX Lowtech Rad fee schedule,"$1,364.40 ",90% of total billed charges,"$1,212.80 ",80% of total billed charges,"$1,364.40 ",90% of total billed charges,"$1,137.00 ",75% of total billed charges,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$564.92 ,100% of Medicare outpatient rates,$298.71 ,100% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,"$1,015.72 ",67% of total billed charges,$294.88 ,105% of 2012 Medicare outpatient rates,$370.44 ,80% of Medicare outpatient rates,"$1,212.80 ",80% of total billed charges,$985.40 ,65% of total billed charges,$367.41 ,123% TX Medicaid Rad fee schedule,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$463.06 ,100% of Medicare outpatient rates,$298.71 ,100% TX Medicaid Rad fee schedule,$298.71 ,100% TX Medicaid Rad fee schedule,$298.71 ,100% TX Medicaid Rad fee schedule,$298.71 ,100% TX Medicaid Rad fee schedule,$298.71 ,100% TX Medicaid Rad fee schedule,$298.71 ,100% TX Medicaid Rad fee schedule,$294.88 ,"$1,364.40 ",$606.40 
Outpatient Medical Services,RADIOLOGY,78700,NM RENAL SCAN,340,$872.00 ,$741.20 ,85% of total billed charges,$671.44 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$610.73 ,385% BCBSTX Lowtech Rad fee schedule,$636.11 ,401% BCBSTX Lowtech Rad fee schedule,$636.11 ,401% BCBSTX Lowtech Rad fee schedule,$636.11 ,401% BCBSTX Lowtech Rad fee schedule,$784.80 ,90% of total billed charges,$697.60 ,80% of total billed charges,$784.80 ,90% of total billed charges,$654.00 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$168.74 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$584.24 ,67% of total billed charges,$297.04 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$697.60 ,80% of total billed charges,$566.80 ,65% of total billed charges,$207.55 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,100% TX Medicaid Rad fee schedule,$168.74 ,$784.80 ,$348.80 
Outpatient Medical Services,RADIOLOGY,78800,NM LOCAL BREAST TUMOR LIMITED,340,$952.00 ,$809.20 ,85% of total billed charges,$733.04 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$648.03 ,385% BCBSTX Lowtech Rad fee schedule,$674.96 ,401% BCBSTX Lowtech Rad fee schedule,$674.96 ,401% BCBSTX Lowtech Rad fee schedule,$674.96 ,401% BCBSTX Lowtech Rad fee schedule,$856.80 ,90% of total billed charges,$761.60 ,80% of total billed charges,$856.80 ,90% of total billed charges,$714.00 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$251.60 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$637.84 ,67% of total billed charges,$261.13 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$761.60 ,80% of total billed charges,$618.80 ,65% of total billed charges,$309.47 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,100% TX Medicaid Rad fee schedule,$251.60 ,$856.80 ,$380.80 
Outpatient Medical Services,RADIOLOGY,78801,NM LOCAL BREAST TUMOR-MULTIPLE,340,"$1,336.00 ","$1,135.60 ",85% of total billed charges,"$1,028.72 ",77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$896.74 ,385% BCBSTX Lowtech Rad fee schedule,$934.01 ,401% BCBSTX Lowtech Rad fee schedule,$934.01 ,401% BCBSTX Lowtech Rad fee schedule,$934.01 ,401% BCBSTX Lowtech Rad fee schedule,"$1,202.40 ",90% of total billed charges,"$1,068.80 ",80% of total billed charges,"$1,202.40 ",90% of total billed charges,"$1,002.00 ",75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$277.66 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$895.12 ,67% of total billed charges,$459.22 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,"$1,068.80 ",80% of total billed charges,$868.40 ,65% of total billed charges,$341.52 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,100% TX Medicaid Rad fee schedule,$277.66 ,"$1,202.40 ",$534.40 
Outpatient Medical Services,RADIOLOGY,78803,NM LIVER SCAN WITH SPECT,340,"$2,244.00 ","$1,907.40 ",85% of total billed charges,"$1,727.88 ",77% of total billed charges,"$1,218.24 ",100% of Medicare outpatient rates,"$1,184.14 ",385% BCBSTX Lowtech Rad fee schedule,"$1,233.36 ",401% BCBSTX Lowtech Rad fee schedule,"$1,233.36 ",401% BCBSTX Lowtech Rad fee schedule,"$1,233.36 ",401% BCBSTX Lowtech Rad fee schedule,"$2,019.60 ",90% of total billed charges,"$1,795.20 ",80% of total billed charges,"$2,019.60 ",90% of total billed charges,"$1,683.00 ",75% of total billed charges,"$1,486.25 ",100% of Medicare outpatient rates,"$1,486.25 ",100% of Medicare outpatient rates,"$1,486.25 ",100% of Medicare outpatient rates,$380.24 ,100% TX Medicaid Rad fee schedule,"$1,218.24 ",100% of Medicare outpatient rates,"$1,503.48 ",67% of total billed charges,$459.22 ,105% of 2012 Medicare outpatient rates,$974.59 ,80% of Medicare outpatient rates,"$1,795.20 ",80% of total billed charges,"$1,458.60 ",65% of total billed charges,$467.70 ,123% TX Medicaid Rad fee schedule,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,"$1,218.24 ",100% of Medicare outpatient rates,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,100% TX Medicaid Rad fee schedule,$380.24 ,"$2,019.60 ",$897.60 
Outpatient Medical Services,RADIOLOGY,78258,NM ESOPHAGEAL MOTILITY,341,$881.00 ,$748.85 ,85% of total billed charges,$678.37 ,77% of total billed charges,$356.75 ,100% of Medicare outpatient rates,$766.84 ,385% BCBSTX Lowtech Rad fee schedule,$798.71 ,401% BCBSTX Lowtech Rad fee schedule,$798.71 ,401% BCBSTX Lowtech Rad fee schedule,$798.71 ,401% BCBSTX Lowtech Rad fee schedule,$792.90 ,90% of total billed charges,$704.80 ,80% of total billed charges,$792.90 ,90% of total billed charges,$660.75 ,75% of total billed charges,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$435.23 ,100% of Medicare outpatient rates,$209.84 ,100% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$590.27 ,67% of total billed charges,$227.14 ,105% of 2012 Medicare outpatient rates,$285.39 ,80% of Medicare outpatient rates,$704.80 ,80% of total billed charges,$572.65 ,65% of total billed charges,$258.10 ,123% TX Medicaid Rad fee schedule,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$356.75 ,100% of Medicare outpatient rates,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,100% TX Medicaid Rad fee schedule,$209.84 ,$798.71 ,$352.40 
Outpatient Medical Services,RADIOLOGY,70450,"CT scan, head or brain, without contrast",350,"$2,044.00 ",$550.00 ,CASE RATE,"$1,573.88 ",77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$565.43 ,494% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,"$1,839.60 ",90% of total billed charges,"$1,635.20 ",80% of total billed charges,"$1,839.60 ",90% of total billed charges,"$1,533.00 ",75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,"$1,369.48 ",67% of total billed charges,$178.87 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,"$1,635.20 ",80% of total billed charges,"$1,328.60 ",65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,"$1,839.60 ",$817.60 
Outpatient Medical Services,RADIOLOGY,70460,CT HEAD WITH CONTRAST,350,"$2,485.00 ",$550.00 ,CASE RATE,"$1,913.45 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,236.50 ",90% of total billed charges,"$1,988.00 ",80% of total billed charges,"$2,236.50 ",90% of total billed charges,"$1,863.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$153.36 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,664.95 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,988.00 ",80% of total billed charges,"$1,615.25 ",65% of total billed charges,$188.63 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$153.36 ,100% TX Medicaid Rad fee schedule,$153.36 ,100% TX Medicaid Rad fee schedule,$153.36 ,100% TX Medicaid Rad fee schedule,$153.36 ,100% TX Medicaid Rad fee schedule,$153.36 ,100% TX Medicaid Rad fee schedule,$153.36 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,236.50 ",$994.00 
Outpatient Medical Services,RADIOLOGY,70470,CT HEAD WITH/WITHOUT CONTRAST,350,"$2,896.00 ",$550.00 ,CASE RATE,"$2,229.92 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,606.40 ",90% of total billed charges,"$2,316.80 ",80% of total billed charges,"$2,606.40 ",90% of total billed charges,"$2,172.00 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,940.32 ",67% of total billed charges,$311.42 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$2,316.80 ",80% of total billed charges,"$1,882.40 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,606.40 ","$1,158.40 "
Outpatient Medical Services,RADIOLOGY,70480,CT ORBITS WITHOUT CONTRAST,350,"$1,625.00 ",$550.00 ,CASE RATE,"$1,251.25 ",77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$565.43 ,494% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,"$1,462.50 ",90% of total billed charges,"$1,300.00 ",80% of total billed charges,"$1,462.50 ",90% of total billed charges,"$1,218.75 ",75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,"$1,088.75 ",67% of total billed charges,$178.87 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,"$1,300.00 ",80% of total billed charges,"$1,056.25 ",65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,"$1,462.50 ",$650.00 
Outpatient Medical Services,RADIOLOGY,70481,CT ORBITS WITH CONTRAST,350,"$1,725.00 ",$550.00 ,CASE RATE,"$1,328.25 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,552.50 ",90% of total billed charges,"$1,380.00 ",80% of total billed charges,"$1,552.50 ",90% of total billed charges,"$1,293.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,155.75 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,380.00 ",80% of total billed charges,"$1,121.25 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,552.50 ",$690.00 
Outpatient Medical Services,RADIOLOGY,70482,CT ORBITS W/WITHOUT CONTRAST,350,"$1,434.00 ",$550.00 ,CASE RATE,"$1,104.18 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,290.60 ",90% of total billed charges,"$1,147.20 ",80% of total billed charges,"$1,290.60 ",90% of total billed charges,"$1,075.50 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$960.78 ,67% of total billed charges,$311.42 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,147.20 ",80% of total billed charges,$932.10 ,65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,301.61 ",$573.60 
Outpatient Medical Services,RADIOLOGY,70486,CT SINUSES W/O CONTRAST,350,"$2,089.00 ",$550.00 ,CASE RATE,"$1,608.53 ",77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$565.43 ,494% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,"$1,880.10 ",90% of total billed charges,"$1,671.20 ",80% of total billed charges,"$1,880.10 ",90% of total billed charges,"$1,566.75 ",75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,"$1,399.63 ",67% of total billed charges,$178.87 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,"$1,671.20 ",80% of total billed charges,"$1,357.85 ",65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,"$1,880.10 ",$835.60 
Outpatient Medical Services,RADIOLOGY,70487,CT SINUSES WITH CONTRAST,350,"$1,904.00 ",$550.00 ,CASE RATE,"$1,466.08 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,713.60 ",90% of total billed charges,"$1,523.20 ",80% of total billed charges,"$1,713.60 ",90% of total billed charges,"$1,428.00 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$157.71 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,275.68 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,523.20 ",80% of total billed charges,"$1,237.60 ",65% of total billed charges,$193.98 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$157.71 ,100% TX Medicaid Rad fee schedule,$157.71 ,100% TX Medicaid Rad fee schedule,$157.71 ,100% TX Medicaid Rad fee schedule,$157.71 ,100% TX Medicaid Rad fee schedule,$157.71 ,100% TX Medicaid Rad fee schedule,$157.71 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,713.60 ",$761.60 
Outpatient Medical Services,RADIOLOGY,70488,CT SINUSES W/WO CONTRAST,350,"$1,993.00 ",$550.00 ,CASE RATE,"$1,534.61 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,793.70 ",90% of total billed charges,"$1,594.40 ",80% of total billed charges,"$1,793.70 ",90% of total billed charges,"$1,494.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,335.31 ",67% of total billed charges,$311.42 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,594.40 ",80% of total billed charges,"$1,295.45 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,793.70 ",$797.20 
Outpatient Medical Services,RADIOLOGY,70490,CT SOFT TISSUE NECK W/O CONT.,350,"$1,775.00 ",$550.00 ,CASE RATE,"$1,366.75 ",77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$565.43 ,494% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,"$1,597.50 ",90% of total billed charges,"$1,420.00 ",80% of total billed charges,"$1,597.50 ",90% of total billed charges,"$1,331.25 ",75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,"$1,189.25 ",67% of total billed charges,$178.87 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,"$1,420.00 ",80% of total billed charges,"$1,153.75 ",65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,"$1,597.50 ",$710.00 
Outpatient Medical Services,RADIOLOGY,70491,CT SOFT TISSUE NECK W/ CONTR.,350,"$2,129.00 ",$550.00 ,CASE RATE,"$1,639.33 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,916.10 ",90% of total billed charges,"$1,703.20 ",80% of total billed charges,"$1,916.10 ",90% of total billed charges,"$1,596.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,426.43 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,703.20 ",80% of total billed charges,"$1,383.85 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,916.10 ",$851.60 
Outpatient Medical Services,RADIOLOGY,70492,CT SOFT TISSUE NECK W/WO CONT,350,"$2,412.00 ",$550.00 ,CASE RATE,"$1,857.24 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,170.80 ",90% of total billed charges,"$1,929.60 ",80% of total billed charges,"$2,170.80 ",90% of total billed charges,"$1,809.00 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,616.04 ",67% of total billed charges,$311.42 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,929.60 ",80% of total billed charges,"$1,567.80 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,170.80 ",$964.80 
Outpatient Medical Services,RADIOLOGY,70496,CTA HEAD WO/W CONTRAST,350,"$2,499.00 ",$550.00 ,CASE RATE,"$1,924.23 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,249.10 ",90% of total billed charges,"$1,999.20 ",80% of total billed charges,"$2,249.10 ",90% of total billed charges,"$1,874.25 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,674.33 ",67% of total billed charges,$315.52 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,999.20 ",80% of total billed charges,"$1,624.35 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,249.10 ",$999.60 
Outpatient Medical Services,RADIOLOGY,70498,CTA NECK WO/W CONTRAST,350,"$2,366.00 ",$550.00 ,CASE RATE,"$1,821.82 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,129.40 ",90% of total billed charges,"$1,892.80 ",80% of total billed charges,"$2,129.40 ",90% of total billed charges,"$1,774.50 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,585.22 ",67% of total billed charges,$315.52 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,892.80 ",80% of total billed charges,"$1,537.90 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,129.40 ",$946.40 
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,"$2,097.00 ",$550.00 ,CASE RATE,"$1,614.69 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,887.30 ",90% of total billed charges,"$1,677.60 ",80% of total billed charges,"$1,887.30 ",90% of total billed charges,"$1,572.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,404.99 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$1,677.60 ",80% of total billed charges,"$1,363.05 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$1,887.30 ",$838.80 
Outpatient Medical Services,RADIOLOGY,74150,CT ABDOMEN WITHOUT CONTRAST,350,"$2,248.00 ",$550.00 ,CASE RATE,"$1,730.96 ",77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$565.43 ,494% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,$589.47 ,515% BCBSTX Hitech Rad fee schedule,"$2,023.20 ",90% of total billed charges,"$1,798.40 ",80% of total billed charges,"$2,023.20 ",90% of total billed charges,"$1,686.00 ",75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,"$1,506.16 ",67% of total billed charges,$178.87 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,"$1,798.40 ",80% of total billed charges,"$1,461.20 ",65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,"$2,023.20 ",$899.20 
Outpatient Medical Services,RADIOLOGY,74160,CT ABDOMEN WITH CONTRAS,350,"$2,797.00 ",$550.00 ,CASE RATE,"$2,153.69 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,517.30 ",90% of total billed charges,"$2,237.60 ",80% of total billed charges,"$2,517.30 ",90% of total billed charges,"$2,097.75 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,873.99 ",67% of total billed charges,$280.11 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$2,237.60 ",80% of total billed charges,"$1,818.05 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,517.30 ","$1,118.80 "
Outpatient Medical Services,RADIOLOGY,74170,CT ABDOMEN W/WO CONTRAST,350,"$2,875.00 ",$550.00 ,CASE RATE,"$2,213.75 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,587.50 ",90% of total billed charges,"$2,300.00 ",80% of total billed charges,"$2,587.50 ",90% of total billed charges,"$2,156.25 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,926.25 ",67% of total billed charges,$311.42 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$2,300.00 ",80% of total billed charges,"$1,868.75 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,587.50 ","$1,150.00 "
Outpatient Medical Services,RADIOLOGY,74174,CTA ABDOMEN/PELVIS WO/W CONTRA,350,"$2,680.00 ",$550.00 ,CASE RATE,"$2,063.60 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,244.58 ",494% BCBSTX Hitech Rad fee schedule,"$1,297.49 ",515% BCBSTX Hitech Rad fee schedule,"$1,297.49 ",515% BCBSTX Hitech Rad fee schedule,"$1,297.49 ",515% BCBSTX Hitech Rad fee schedule,"$2,412.00 ",90% of total billed charges,"$2,144.00 ",80% of total billed charges,"$2,412.00 ",90% of total billed charges,"$2,010.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$368.43 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$1,795.60 ",67% of total billed charges,$541.17 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,144.00 ",80% of total billed charges,"$1,742.00 ",65% of total billed charges,$453.17 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,412.00 ","$1,072.00 "
Outpatient Medical Services,RADIOLOGY,74175,CTA ABDOMEN WO/W CONTRAST,350,"$2,631.00 ",$550.00 ,CASE RATE,"$2,025.87 ",77% of total billed charges,$165.52 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,367.90 ",90% of total billed charges,"$2,104.80 ",80% of total billed charges,"$2,367.90 ",90% of total billed charges,"$1,973.25 ",75% of total billed charges,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$201.93 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,"$1,762.77 ",67% of total billed charges,$315.52 ,105% of 2012 Medicare outpatient rates,$132.41 ,80% of Medicare outpatient rates,"$2,104.80 ",80% of total billed charges,"$1,710.15 ",65% of total billed charges,$221.82 ,123% TX Medicaid Rad fee schedule,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$165.52 ,100% of Medicare outpatient rates,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$180.34 ,100% TX Medicaid Rad fee schedule,$132.41 ,"$2,367.90 ","$1,052.40 "
Outpatient Medical Services,RADIOLOGY,74176,CT ABDOMEN & PELVIS WITHOUT,350,"$2,305.00 ",$550.00 ,CASE RATE,"$1,774.85 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,074.50 ",90% of total billed charges,"$1,844.00 ",80% of total billed charges,"$2,074.50 ",90% of total billed charges,"$1,728.75 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$189.79 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,544.35 ",67% of total billed charges,$377.69 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$1,844.00 ",80% of total billed charges,"$1,498.25 ",65% of total billed charges,$233.44 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$189.79 ,100% TX Medicaid Rad fee schedule,$189.79 ,100% TX Medicaid Rad fee schedule,$189.79 ,100% TX Medicaid Rad fee schedule,$189.79 ,100% TX Medicaid Rad fee schedule,$189.79 ,100% TX Medicaid Rad fee schedule,$189.79 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,074.50 ",$922.00 
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,350,"$3,106.00 ",$550.00 ,CASE RATE,"$2,391.62 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,795.40 ",90% of total billed charges,"$2,484.80 ",80% of total billed charges,"$2,795.40 ",90% of total billed charges,"$2,329.50 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$318.09 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,081.02 ",67% of total billed charges,$541.17 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,484.80 ",80% of total billed charges,"$2,018.90 ",65% of total billed charges,$391.25 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$318.09 ,100% TX Medicaid Rad fee schedule,$318.09 ,100% TX Medicaid Rad fee schedule,$318.09 ,100% TX Medicaid Rad fee schedule,$318.09 ,100% TX Medicaid Rad fee schedule,$318.09 ,100% TX Medicaid Rad fee schedule,$318.09 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,795.40 ","$1,242.40 "
Outpatient Medical Services,RADIOLOGY,74178,CT ABDOMEN & PELVIS W & W/O,350,"$2,522.00 ",$550.00 ,CASE RATE,"$1,941.94 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,269.80 ",90% of total billed charges,"$2,017.60 ",80% of total billed charges,"$2,269.80 ",90% of total billed charges,"$1,891.50 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$356.19 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$1,689.74 ",67% of total billed charges,$541.17 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,017.60 ",80% of total billed charges,"$1,639.30 ",65% of total billed charges,$438.11 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$356.19 ,100% TX Medicaid Rad fee schedule,$356.19 ,100% TX Medicaid Rad fee schedule,$356.19 ,100% TX Medicaid Rad fee schedule,$356.19 ,100% TX Medicaid Rad fee schedule,$356.19 ,100% TX Medicaid Rad fee schedule,$356.19 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,269.80 ","$1,008.80 "
Outpatient Medical Services,RADIOLOGY,76641,US BREAST COMPLETE LEFT,400,$603.00 ,$512.55 ,85% of total billed charges,$464.31 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$542.70 ,90% of total billed charges,$482.40 ,80% of total billed charges,$542.70 ,90% of total billed charges,$452.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$103.91 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$404.01 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$78.48 ,80% of Medicare outpatient rates,$482.40 ,80% of total billed charges,$391.95 ,65% of total billed charges,$127.81 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$103.91 ,100% TX Medicaid Rad fee schedule,$103.91 ,100% TX Medicaid Rad fee schedule,$103.91 ,100% TX Medicaid Rad fee schedule,$103.91 ,100% TX Medicaid Rad fee schedule,$103.91 ,100% TX Medicaid Rad fee schedule,$103.91 ,100% TX Medicaid Rad fee schedule,$78.48 ,$542.70 ,$241.20 
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,401,$410.00 ,$348.50 ,85% of total billed charges,$315.70 ,77% of total billed charges,$84.28 ,100% of Medicare outpatient rates,$368.91 ,385% BCBSTX Lowtech Rad fee schedule,$384.24 ,401% BCBSTX Lowtech Rad fee schedule,$384.24 ,401% BCBSTX Lowtech Rad fee schedule,$384.24 ,401% BCBSTX Lowtech Rad fee schedule,$369.00 ,90% of total billed charges,$328.00 ,80% of total billed charges,$369.00 ,90% of total billed charges,$307.50 ,75% of total billed charges,$102.82 ,100% of Medicare outpatient rates,$102.82 ,100% of Medicare outpatient rates,$102.82 ,100% of Medicare outpatient rates,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$84.28 ,100% of Medicare outpatient rates,$274.70 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$67.42 ,80% of Medicare outpatient rates,$328.00 ,80% of total billed charges,$266.50 ,65% of total billed charges,$146.25 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$84.28 ,100% of Medicare outpatient rates,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$118.90 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.42 ,$384.24 ,$164.00 
Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,401,$525.00 ,$446.25 ,85% of total billed charges,$404.25 ,77% of total billed charges,$107.45 ,100% of Medicare outpatient rates,$471.16 ,385% BCBSTX Lowtech Rad fee schedule,$490.74 ,401% BCBSTX Lowtech Rad fee schedule,$490.74 ,401% BCBSTX Lowtech Rad fee schedule,$490.74 ,401% BCBSTX Lowtech Rad fee schedule,$472.50 ,90% of total billed charges,$420.00 ,80% of total billed charges,$472.50 ,90% of total billed charges,$393.75 ,75% of total billed charges,$131.09 ,100% of Medicare outpatient rates,$131.09 ,100% of Medicare outpatient rates,$131.09 ,100% of Medicare outpatient rates,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$107.45 ,100% of Medicare outpatient rates,$351.75 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$85.96 ,80% of Medicare outpatient rates,$420.00 ,80% of total billed charges,$341.25 ,65% of total billed charges,$187.27 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$107.45 ,100% of Medicare outpatient rates,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$152.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$85.96 ,$490.74 ,$210.00 
Outpatient Medical Services,RADIOLOGY,77067,"Mammography, screening, bilateral",401,$436.00 ,$370.60 ,85% of total billed charges,$335.72 ,77% of total billed charges,$89.10 ,100% of Medicare outpatient rates,$389.66 ,385% BCBSTX Lowtech Rad fee schedule,$405.85 ,401% BCBSTX Lowtech Rad fee schedule,$405.85 ,401% BCBSTX Lowtech Rad fee schedule,$405.85 ,401% BCBSTX Lowtech Rad fee schedule,$392.40 ,90% of total billed charges,$348.80 ,80% of total billed charges,$392.40 ,90% of total billed charges,$327.00 ,75% of total billed charges,$108.70 ,100% of Medicare outpatient rates,$108.70 ,100% of Medicare outpatient rates,$108.70 ,100% of Medicare outpatient rates,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.10 ,100% of Medicare outpatient rates,$292.12 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$71.28 ,80% of Medicare outpatient rates,$348.80 ,80% of total billed charges,$283.40 ,65% of total billed charges,$155.52 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$89.10 ,100% of Medicare outpatient rates,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$126.44 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$71.28 ,$405.85 ,$174.40 
Outpatient Medical Services,RADIOLOGY,76642,US BREAST COMPLETE RIGHT,402,$298.00 ,$253.30 ,85% of total billed charges,$229.46 ,77% of total billed charges,$79.74 ,100% of Medicare outpatient rates,$239.16 ,385% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$249.10 ,401% BCBSTX Lowtech Rad fee schedule,$268.20 ,90% of total billed charges,$238.40 ,80% of total billed charges,$268.20 ,90% of total billed charges,$223.50 ,75% of total billed charges,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$97.28 ,100% of Medicare outpatient rates,$85.54 ,100% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$199.66 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$63.79 ,80% of Medicare outpatient rates,$238.40 ,80% of total billed charges,$193.70 ,65% of total billed charges,$105.21 ,123% TX Medicaid Rad fee schedule,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$79.74 ,100% of Medicare outpatient rates,$85.54 ,100% TX Medicaid Rad fee schedule,$85.54 ,100% TX Medicaid Rad fee schedule,$85.54 ,100% TX Medicaid Rad fee schedule,$85.54 ,100% TX Medicaid Rad fee schedule,$85.54 ,100% TX Medicaid Rad fee schedule,$85.54 ,100% TX Medicaid Rad fee schedule,$63.79 ,$268.20 ,$119.20 
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,$695.00 ,$590.75 ,85% of total billed charges,$535.15 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$440.67 ,385% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$458.98 ,401% BCBSTX Lowtech Rad fee schedule,$625.50 ,90% of total billed charges,$556.00 ,80% of total billed charges,$625.50 ,90% of total billed charges,$521.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$465.65 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$556.00 ,80% of total billed charges,$451.75 ,65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,$625.50 ,$278.00 
Outpatient Medical Services,RADIOLOGY,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,$605.00 ,$514.25 ,85% of total billed charges,$465.85 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$362.02 ,385% BCBSTX Lowtech Rad fee schedule,$377.06 ,401% BCBSTX Lowtech Rad fee schedule,$377.06 ,401% BCBSTX Lowtech Rad fee schedule,$377.06 ,401% BCBSTX Lowtech Rad fee schedule,$544.50 ,90% of total billed charges,$484.00 ,80% of total billed charges,$544.50 ,90% of total billed charges,$453.75 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$405.35 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$484.00 ,80% of total billed charges,$393.25 ,65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,$544.50 ,$242.00 
Outpatient Medical Services,RADIOLOGY,76818,BIOPHYSICAL PROFILE WITH NON-STRESS TEST,402,$466.00 ,$396.10 ,85% of total billed charges,$358.82 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$272.20 ,385% BCBSTX Lowtech Rad fee schedule,$283.51 ,401% BCBSTX Lowtech Rad fee schedule,$283.51 ,401% BCBSTX Lowtech Rad fee schedule,$283.51 ,401% BCBSTX Lowtech Rad fee schedule,$419.40 ,90% of total billed charges,$372.80 ,80% of total billed charges,$419.40 ,90% of total billed charges,$349.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$312.22 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$372.80 ,80% of total billed charges,$302.90 ,65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,$419.40 ,$186.40 
Outpatient Medical Services,RADIOLOGY,76819,BIOPHYSICAL PROFILE WITHOUT NON-STRESS TEST,402,$408.00 ,$346.80 ,85% of total billed charges,$314.16 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$198.97 ,385% BCBSTX Lowtech Rad fee schedule,$207.24 ,401% BCBSTX Lowtech Rad fee schedule,$207.24 ,401% BCBSTX Lowtech Rad fee schedule,$207.24 ,401% BCBSTX Lowtech Rad fee schedule,$367.20 ,90% of total billed charges,$326.40 ,80% of total billed charges,$367.20 ,90% of total billed charges,$306.00 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$84.20 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$273.36 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$326.40 ,80% of total billed charges,$265.20 ,65% of total billed charges,$103.57 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$84.20 ,100% TX Medicaid Rad fee schedule,$84.20 ,100% TX Medicaid Rad fee schedule,$84.20 ,100% TX Medicaid Rad fee schedule,$84.20 ,100% TX Medicaid Rad fee schedule,$84.20 ,100% TX Medicaid Rad fee schedule,$84.20 ,100% TX Medicaid Rad fee schedule,$78.47 ,$367.20 ,$163.20 
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound pelvis through vagina,402,$596.00 ,$506.60 ,85% of total billed charges,$458.92 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$344.04 ,385% BCBSTX Lowtech Rad fee schedule,$358.33 ,401% BCBSTX Lowtech Rad fee schedule,$358.33 ,401% BCBSTX Lowtech Rad fee schedule,$358.33 ,401% BCBSTX Lowtech Rad fee schedule,$536.40 ,90% of total billed charges,$476.80 ,80% of total billed charges,$536.40 ,90% of total billed charges,$447.00 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$399.32 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$476.80 ,80% of total billed charges,$387.40 ,65% of total billed charges,$131.46 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$106.88 ,100% TX Medicaid Rad fee schedule,$78.47 ,$536.40 ,$238.40 
Outpatient Medical Services,RADIOLOGY,92523,SPEECH THERAPY EVALUATION,440,$963.00 ,$818.55 ,85% of total billed charges,$741.51 ,77% of total billed charges,$224.44 ,100% of Medicare outpatient rates,$862.20 ,429% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$866.70 ,90% of total billed charges,$770.40 ,80% of total billed charges,$866.70 ,90% of total billed charges,$722.25 ,75% of total billed charges,$273.82 ,100% of Medicare outpatient rates,$273.82 ,100% of Medicare outpatient rates,$273.82 ,100% of Medicare outpatient rates,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$224.44 ,100% of Medicare outpatient rates,$645.21 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$179.55 ,80% of Medicare outpatient rates,$770.40 ,80% of total billed charges,$625.95 ,65% of total billed charges,$343.50 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$179.55 ,$898.38 ,$385.20 
Outpatient Medical Services,RADIOLOGY,93303,TRANSTHORACIC ECHO/CONG CARD,480,"$1,463.00 ","$1,243.55 ",85% of total billed charges,"$1,126.51 ",77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,$775.98 ,429% BCBSTX Other fee schedule,$808.53 ,447% BCBSTX Other fee schedule,$808.53 ,447% BCBSTX Other fee schedule,$808.53 ,447% BCBSTX Other fee schedule,"$1,316.70 ",90% of total billed charges,"$1,170.40 ",80% of total billed charges,"$1,316.70 ",90% of total billed charges,"$1,097.25 ",75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$227.88 ,100% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$980.21 ,67% of total billed charges,$540.04 ,105% of 2012 Medicare outpatient rates,$369.43 ,80% of Medicare outpatient rates,"$1,170.40 ",80% of total billed charges,$950.95 ,65% of total billed charges,$280.29 ,123% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,100% TX Medicaid Rad fee schedule,$227.88 ,"$1,316.70 ",$585.20 
Outpatient Medical Services,RADIOLOGY,93306,ECHO - COMPLETE,480,"$2,400.00 ","$2,040.00 ",85% of total billed charges,"$1,848.00 ",77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,$594.29 ,429% BCBSTX Other fee schedule,$619.23 ,447% BCBSTX Other fee schedule,$619.23 ,447% BCBSTX Other fee schedule,$619.23 ,447% BCBSTX Other fee schedule,"$2,160.00 ",90% of total billed charges,"$1,920.00 ",80% of total billed charges,"$2,160.00 ",90% of total billed charges,"$1,800.00 ",75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$461.80 ,100% of Medicare outpatient rates,"$1,608.00 ",67% of total billed charges,$366.13 ,105% of 2012 Medicare outpatient rates,$369.43 ,80% of Medicare outpatient rates,"$1,920.00 ",80% of total billed charges,"$1,560.00 ",65% of total billed charges,$856.08 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$696.00 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$366.13 ,"$2,160.00 ",$960.00 
Outpatient Medical Services,RADIOLOGY,93308,ECHO LIMITED/6 MO OR F/UP,480,$559.00 ,$475.15 ,85% of total billed charges,$430.43 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$349.51 ,429% BCBSTX Other fee schedule,$364.17 ,447% BCBSTX Other fee schedule,$364.17 ,447% BCBSTX Other fee schedule,$364.17 ,447% BCBSTX Other fee schedule,$503.10 ,90% of total billed charges,$447.20 ,80% of total billed charges,$503.10 ,90% of total billed charges,$419.25 ,75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$98.56 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$374.53 ,67% of total billed charges,$206.16 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,$447.20 ,80% of total billed charges,$363.35 ,65% of total billed charges,$121.23 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,100% TX Medicaid Rad fee schedule,$98.56 ,$503.10 ,$223.60 
Outpatient Medical Services,RADIOLOGY,93320,CW/PW DOPPLER,480,$607.00 ,$515.95 ,85% of total billed charges,$467.39 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$157.06 ,429% BCBSTX Other fee schedule,$163.65 ,447% BCBSTX Other fee schedule,$163.65 ,447% BCBSTX Other fee schedule,$163.65 ,447% BCBSTX Other fee schedule,$546.30 ,90% of total billed charges,$485.60 ,80% of total billed charges,$546.30 ,90% of total billed charges,$455.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$406.69 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$485.60 ,80% of total billed charges,$394.55 ,65% of total billed charges,$216.52 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$157.06 ,$546.30 ,$242.80 
Outpatient Medical Services,RADIOLOGY,93325,COLOR FLOW DOPPLER,480,$607.00 ,$515.95 ,85% of total billed charges,$467.39 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$98.54 ,429% BCBSTX Other fee schedule,$102.68 ,447% BCBSTX Other fee schedule,$102.68 ,447% BCBSTX Other fee schedule,$102.68 ,447% BCBSTX Other fee schedule,$546.30 ,90% of total billed charges,$485.60 ,80% of total billed charges,$546.30 ,90% of total billed charges,$455.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$406.69 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$485.60 ,80% of total billed charges,$394.55 ,65% of total billed charges,$216.52 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$176.03 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.54 ,$546.30 ,$242.80 
Outpatient Medical Services,RADIOLOGY,93350,STRESS ECHO,480,"$1,222.00 ","$1,038.70 ",85% of total billed charges,$940.94 ,77% of total billed charges,$461.80 ,100% of Medicare outpatient rates,$595.84 ,429% BCBSTX Other fee schedule,$620.84 ,447% BCBSTX Other fee schedule,$620.84 ,447% BCBSTX Other fee schedule,$620.84 ,447% BCBSTX Other fee schedule,"$1,099.80 ",90% of total billed charges,$977.60 ,80% of total billed charges,"$1,099.80 ",90% of total billed charges,$916.50 ,75% of total billed charges,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$563.39 ,100% of Medicare outpatient rates,$188.45 ,100% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$818.74 ,67% of total billed charges,$366.13 ,105% of 2012 Medicare outpatient rates,$369.43 ,80% of Medicare outpatient rates,$977.60 ,80% of total billed charges,$794.30 ,65% of total billed charges,$231.79 ,123% TX Medicaid Rad fee schedule,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$461.80 ,100% of Medicare outpatient rates,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,100% TX Medicaid Rad fee schedule,$188.45 ,"$1,099.80 ",$488.80 
Outpatient Medical Services,RADIOLOGY,93017,STRESS TEST,482,"$1,191.00 ","$1,012.35 ",85% of total billed charges,$917.07 ,77% of total billed charges,$257.05 ,100% of Medicare outpatient rates,"$1,067.48 ",429% BCBSTX Other fee schedule,"$1,112.27 ",447% BCBSTX Other fee schedule,"$1,112.27 ",447% BCBSTX Other fee schedule,"$1,112.27 ",447% BCBSTX Other fee schedule,"$1,071.90 ",90% of total billed charges,$952.80 ,80% of total billed charges,"$1,071.90 ",90% of total billed charges,$893.25 ,75% of total billed charges,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$797.97 ,67% of total billed charges,$166.12 ,105% of 2012 Medicare outpatient rates,$205.64 ,80% of Medicare outpatient rates,$952.80 ,80% of total billed charges,$774.15 ,65% of total billed charges,$424.83 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$345.39 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$166.12 ,"$1,112.27 ",$476.40 
Outpatient Medical Services,RADIOLOGY,70540,"MRI ORBIT, FACE AND NECK W/O",610,"$2,611.00 ",$725.00 ,CASE RATE,"$2,010.47 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,349.90 ",90% of total billed charges,"$2,088.80 ",80% of total billed charges,"$2,349.90 ",90% of total billed charges,"$1,958.25 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$233.52 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,749.37 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,088.80 ",80% of total billed charges,"$1,697.15 ",65% of total billed charges,$287.23 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,349.90 ","$1,044.40 "
Outpatient Medical Services,RADIOLOGY,70542,MRI ORBIT/FACE/NECK W/CONTRAST,610,"$3,400.00 ",$725.00 ,CASE RATE,"$2,618.00 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$3,060.00 ",90% of total billed charges,"$2,720.00 ",80% of total billed charges,"$3,060.00 ",90% of total billed charges,"$2,550.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$281.00 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,278.00 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,720.00 ",80% of total billed charges,"$2,210.00 ",65% of total billed charges,$345.63 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$281.00 ,100% TX Medicaid Rad fee schedule,$281.00 ,100% TX Medicaid Rad fee schedule,$281.00 ,100% TX Medicaid Rad fee schedule,$281.00 ,100% TX Medicaid Rad fee schedule,$281.00 ,100% TX Medicaid Rad fee schedule,$281.00 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$3,060.00 ","$1,360.00 "
Outpatient Medical Services,RADIOLOGY,70543,MRI ORBIT/FACE/NECK W & W/O,610,"$4,157.00 ",$725.00 ,CASE RATE,"$3,200.89 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$3,741.30 ",90% of total billed charges,"$3,325.60 ",80% of total billed charges,"$3,741.30 ",90% of total billed charges,"$3,117.75 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$354.85 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,785.19 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$3,325.60 ",80% of total billed charges,"$2,702.05 ",65% of total billed charges,$436.47 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$354.85 ,100% TX Medicaid Rad fee schedule,$354.85 ,100% TX Medicaid Rad fee schedule,$354.85 ,100% TX Medicaid Rad fee schedule,$354.85 ,100% TX Medicaid Rad fee schedule,$354.85 ,100% TX Medicaid Rad fee schedule,$354.85 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$3,741.30 ","$1,662.80 "
Outpatient Medical Services,RADIOLOGY,70544,MRA HEAD WITHOUT CONTRAST,610,"$4,617.00 ",$725.00 ,CASE RATE,"$3,555.09 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$4,155.30 ",90% of total billed charges,"$3,693.60 ",80% of total billed charges,"$4,155.30 ",90% of total billed charges,"$3,462.75 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$224.54 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$3,093.39 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$3,693.60 ",80% of total billed charges,"$3,001.05 ",65% of total billed charges,$276.18 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$224.54 ,100% TX Medicaid Rad fee schedule,$224.54 ,100% TX Medicaid Rad fee schedule,$224.54 ,100% TX Medicaid Rad fee schedule,$224.54 ,100% TX Medicaid Rad fee schedule,$224.54 ,100% TX Medicaid Rad fee schedule,$224.54 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$4,155.30 ","$1,846.80 "
Outpatient Medical Services,RADIOLOGY,70545,MRA HEAD WITH CONTRAST,610,"$4,531.00 ",$725.00 ,CASE RATE,"$3,488.87 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$4,077.90 ",90% of total billed charges,"$3,624.80 ",80% of total billed charges,"$4,077.90 ",90% of total billed charges,"$3,398.25 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$237.24 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$3,035.77 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$3,624.80 ",80% of total billed charges,"$2,945.15 ",65% of total billed charges,$291.81 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,100% TX Medicaid Rad fee schedule,$237.24 ,"$4,077.90 ","$1,812.40 "
Outpatient Medical Services,RADIOLOGY,70546,MRA  HEAD W & W/O CONTRAST,610,"$5,920.00 ",$725.00 ,CASE RATE,"$4,558.40 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$5,328.00 ",90% of total billed charges,"$4,736.00 ",80% of total billed charges,"$5,328.00 ",90% of total billed charges,"$4,440.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$343.83 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$3,966.40 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$4,736.00 ",80% of total billed charges,"$3,848.00 ",65% of total billed charges,$422.91 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$343.83 ,100% TX Medicaid Rad fee schedule,$343.83 ,100% TX Medicaid Rad fee schedule,$343.83 ,100% TX Medicaid Rad fee schedule,$343.83 ,100% TX Medicaid Rad fee schedule,$343.83 ,100% TX Medicaid Rad fee schedule,$343.83 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$5,328.00 ","$2,368.00 "
Outpatient Medical Services,RADIOLOGY,70547,MRA NECK WITHOUT CONTRAST,610,"$3,696.00 ",$725.00 ,CASE RATE,"$2,845.92 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$3,326.40 ",90% of total billed charges,"$2,956.80 ",80% of total billed charges,"$3,326.40 ",90% of total billed charges,"$2,772.00 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$224.88 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$2,476.32 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,956.80 ",80% of total billed charges,"$2,402.40 ",65% of total billed charges,$276.60 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$224.88 ,100% TX Medicaid Rad fee schedule,$224.88 ,100% TX Medicaid Rad fee schedule,$224.88 ,100% TX Medicaid Rad fee schedule,$224.88 ,100% TX Medicaid Rad fee schedule,$224.88 ,100% TX Medicaid Rad fee schedule,$224.88 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$3,326.40 ","$1,478.40 "
Outpatient Medical Services,RADIOLOGY,70548,MRA NECK WITH CONTRAST,610,"$3,626.00 ",$725.00 ,CASE RATE,"$2,792.02 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$3,263.40 ",90% of total billed charges,"$2,900.80 ",80% of total billed charges,"$3,263.40 ",90% of total billed charges,"$2,719.50 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$256.61 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,429.42 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,900.80 ",80% of total billed charges,"$2,356.90 ",65% of total billed charges,$315.63 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,100% TX Medicaid Rad fee schedule,$256.61 ,"$3,263.40 ","$1,450.40 "
Outpatient Medical Services,RADIOLOGY,70549,MRA NECK WITH & W/OUT CONTRAST,610,"$4,894.00 ",$725.00 ,CASE RATE,"$3,768.38 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$4,404.60 ",90% of total billed charges,"$3,915.20 ",80% of total billed charges,"$4,404.60 ",90% of total billed charges,"$3,670.50 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$360.53 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$3,278.98 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$3,915.20 ",80% of total billed charges,"$3,181.10 ",65% of total billed charges,$443.45 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$360.53 ,100% TX Medicaid Rad fee schedule,$360.53 ,100% TX Medicaid Rad fee schedule,$360.53 ,100% TX Medicaid Rad fee schedule,$360.53 ,100% TX Medicaid Rad fee schedule,$360.53 ,100% TX Medicaid Rad fee schedule,$360.53 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$4,404.60 ","$1,957.60 "
Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,610,"$5,592.00 ",$725.00 ,CASE RATE,"$4,305.84 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$5,032.80 ",90% of total billed charges,"$4,473.60 ",80% of total billed charges,"$5,032.80 ",90% of total billed charges,"$4,194.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$332.80 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$3,746.64 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$4,473.60 ",80% of total billed charges,"$3,634.80 ",65% of total billed charges,$409.34 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$332.80 ,100% TX Medicaid Rad fee schedule,$332.80 ,100% TX Medicaid Rad fee schedule,$332.80 ,100% TX Medicaid Rad fee schedule,$332.80 ,100% TX Medicaid Rad fee schedule,$332.80 ,100% TX Medicaid Rad fee schedule,$332.80 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$5,032.80 ","$2,236.80 "
Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal,610,"$2,772.00 ",$725.00 ,CASE RATE,"$2,134.44 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,494.80 ",90% of total billed charges,"$2,217.60 ",80% of total billed charges,"$2,494.80 ",90% of total billed charges,"$2,079.00 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$199.14 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,857.24 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,217.60 ",80% of total billed charges,"$1,801.80 ",65% of total billed charges,$244.94 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$199.14 ,100% TX Medicaid Rad fee schedule,$199.14 ,100% TX Medicaid Rad fee schedule,$199.14 ,100% TX Medicaid Rad fee schedule,$199.14 ,100% TX Medicaid Rad fee schedule,$199.14 ,100% TX Medicaid Rad fee schedule,$199.14 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,494.80 ","$1,108.80 "
Outpatient Medical Services,RADIOLOGY,73718,MRI LOWER EXTREMITY W/O CONT.,610,"$2,772.00 ",$725.00 ,CASE RATE,"$2,134.44 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,494.80 ",90% of total billed charges,"$2,217.60 ",80% of total billed charges,"$2,494.80 ",90% of total billed charges,"$2,079.00 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$233.52 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,857.24 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,217.60 ",80% of total billed charges,"$1,801.80 ",65% of total billed charges,$287.23 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$233.52 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,494.80 ","$1,108.80 "
Outpatient Medical Services,RADIOLOGY,73719,MRI LOWER EXTREMITY WITH CONT.,610,"$3,172.00 ",$725.00 ,CASE RATE,"$2,442.44 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$1,248.54 ",494% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$1,301.61 ",515% BCBSTX Hitech Rad fee schedule,"$2,854.80 ",90% of total billed charges,"$2,537.60 ",80% of total billed charges,"$2,854.80 ",90% of total billed charges,"$2,379.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$274.65 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,125.24 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,537.60 ",80% of total billed charges,"$2,061.80 ",65% of total billed charges,$337.82 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$274.65 ,100% TX Medicaid Rad fee schedule,$274.65 ,100% TX Medicaid Rad fee schedule,$274.65 ,100% TX Medicaid Rad fee schedule,$274.65 ,100% TX Medicaid Rad fee schedule,$274.65 ,100% TX Medicaid Rad fee schedule,$274.65 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,854.80 ","$1,268.80 "
Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXTREMITY W/O & WITH,610,"$3,327.00 ",$725.00 ,CASE RATE,"$2,561.79 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,994.30 ",90% of total billed charges,"$2,661.60 ",80% of total billed charges,"$2,994.30 ",90% of total billed charges,"$2,495.25 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$353.51 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,229.09 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,661.60 ",80% of total billed charges,"$2,162.55 ",65% of total billed charges,$434.82 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$353.51 ,100% TX Medicaid Rad fee schedule,$353.51 ,100% TX Medicaid Rad fee schedule,$353.51 ,100% TX Medicaid Rad fee schedule,$353.51 ,100% TX Medicaid Rad fee schedule,$353.51 ,100% TX Medicaid Rad fee schedule,$353.51 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,994.30 ","$1,330.80 "
Outpatient Medical Services,RADIOLOGY,73721,MRI scan of leg joint,610,"$2,518.00 ",$725.00 ,CASE RATE,"$1,938.86 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,266.20 ",90% of total billed charges,"$2,014.40 ",80% of total billed charges,"$2,266.20 ",90% of total billed charges,"$1,888.50 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$210.84 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,687.06 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,014.40 ",80% of total billed charges,"$1,636.70 ",65% of total billed charges,$259.33 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$210.84 ,100% TX Medicaid Rad fee schedule,$210.84 ,100% TX Medicaid Rad fee schedule,$210.84 ,100% TX Medicaid Rad fee schedule,$210.84 ,100% TX Medicaid Rad fee schedule,$210.84 ,100% TX Medicaid Rad fee schedule,$210.84 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,266.20 ","$1,007.20 "
Outpatient Medical Services,RADIOLOGY,73722,MRI LOWER EXT JOINT WITH CONT.,610,"$3,874.00 ",$725.00 ,CASE RATE,"$2,982.98 ",77% of total billed charges,$679.90 ,100% of Medicare outpatient rates,"$3,368.49 ",494% BCBSTX Hitech Rad fee schedule,"$3,511.68 ",515% BCBSTX Hitech Rad fee schedule,"$3,511.68 ",515% BCBSTX Hitech Rad fee schedule,"$3,511.68 ",515% BCBSTX Hitech Rad fee schedule,"$3,486.60 ",90% of total billed charges,"$3,099.20 ",80% of total billed charges,"$3,486.60 ",90% of total billed charges,"$2,905.50 ",75% of total billed charges,$829.48 ,100% of Medicare outpatient rates,$829.48 ,100% of Medicare outpatient rates,$829.48 ,100% of Medicare outpatient rates,$328.79 ,100% TX Medicaid Rad fee schedule,$679.90 ,100% of Medicare outpatient rates,"$2,595.58 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$543.91 ,80% of Medicare outpatient rates,"$3,099.20 ",80% of total billed charges,"$2,518.10 ",65% of total billed charges,$404.41 ,123% TX Medicaid Rad fee schedule,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$679.90 ,100% of Medicare outpatient rates,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,100% TX Medicaid Rad fee schedule,$328.79 ,"$3,511.68 ","$1,549.60 "
Outpatient Medical Services,RADIOLOGY,73723,MRI LOWER EXT JOINT W & W/O,610,"$4,157.00 ",$725.00 ,CASE RATE,"$3,200.89 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$3,741.30 ",90% of total billed charges,"$3,325.60 ",80% of total billed charges,"$3,741.30 ",90% of total billed charges,"$3,117.75 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$368.43 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,785.19 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$3,325.60 ",80% of total billed charges,"$2,702.05 ",65% of total billed charges,$453.17 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$368.43 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$3,741.30 ","$1,662.80 "
Outpatient Medical Services,RADIOLOGY,73725,MRI ANGIO LOWER EXTY W/O CONT,610,"$6,533.00 ",$725.00 ,CASE RATE,"$5,030.41 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$1,560.15 ",494% BCBSTX Hitech Rad fee schedule,"$1,626.47 ",515% BCBSTX Hitech Rad fee schedule,"$1,626.47 ",515% BCBSTX Hitech Rad fee schedule,"$1,626.47 ",515% BCBSTX Hitech Rad fee schedule,"$5,879.70 ",90% of total billed charges,"$5,226.40 ",80% of total billed charges,"$5,879.70 ",90% of total billed charges,"$4,899.75 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$4,377.11 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$5,226.40 ",80% of total billed charges,"$4,246.45 ",65% of total billed charges,"$2,330.32 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,894.57 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$725.00 ,"$5,879.70 ","$2,613.20 "
Outpatient Medical Services,RADIOLOGY,74181,MRI ABDOMEN WITHOUT CONTRAST,610,"$2,772.00 ",$725.00 ,CASE RATE,"$2,134.44 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,147.61 ",494% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$1,196.40 ",515% BCBSTX Hitech Rad fee schedule,"$2,494.80 ",90% of total billed charges,"$2,217.60 ",80% of total billed charges,"$2,494.80 ",90% of total billed charges,"$2,079.00 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$204.83 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,"$1,857.24 ",67% of total billed charges,$315.45 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,"$2,217.60 ",80% of total billed charges,"$1,801.80 ",65% of total billed charges,$251.94 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$204.83 ,100% TX Medicaid Rad fee schedule,$204.83 ,100% TX Medicaid Rad fee schedule,$204.83 ,100% TX Medicaid Rad fee schedule,$204.83 ,100% TX Medicaid Rad fee schedule,$204.83 ,100% TX Medicaid Rad fee schedule,$204.83 ,100% TX Medicaid Rad fee schedule,$171.46 ,"$2,494.80 ","$1,108.80 "
Outpatient Medical Services,RADIOLOGY,74182,MRI ABDOMEN WITH CONTRAST,610,"$3,172.00 ",$725.00 ,CASE RATE,"$2,442.44 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,854.80 ",90% of total billed charges,"$2,537.60 ",80% of total billed charges,"$2,854.80 ",90% of total billed charges,"$2,379.00 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$317.43 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,125.24 ",67% of total billed charges,$406.28 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$2,537.60 ",80% of total billed charges,"$2,061.80 ",65% of total billed charges,$390.44 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$317.43 ,100% TX Medicaid Rad fee schedule,$317.43 ,100% TX Medicaid Rad fee schedule,$317.43 ,100% TX Medicaid Rad fee schedule,$317.43 ,100% TX Medicaid Rad fee schedule,$317.43 ,100% TX Medicaid Rad fee schedule,$317.43 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$2,854.80 ","$1,268.80 "
Outpatient Medical Services,RADIOLOGY,74183,MRI ABDOMEN W/O AND WITH CONT,610,"$4,157.00 ",$725.00 ,CASE RATE,"$3,200.89 ",77% of total billed charges,$338.16 ,100% of Medicare outpatient rates,"$2,254.47 ",494% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$2,350.31 ",515% BCBSTX Hitech Rad fee schedule,"$3,741.30 ",90% of total billed charges,"$3,325.60 ",80% of total billed charges,"$3,741.30 ",90% of total billed charges,"$3,117.75 ",75% of total billed charges,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$412.56 ,100% of Medicare outpatient rates,$354.51 ,100% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,"$2,785.19 ",67% of total billed charges,$497.81 ,105% of 2012 Medicare outpatient rates,$270.52 ,80% of Medicare outpatient rates,"$3,325.60 ",80% of total billed charges,"$2,702.05 ",65% of total billed charges,$436.05 ,123% TX Medicaid Rad fee schedule,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$338.16 ,100% of Medicare outpatient rates,$354.51 ,100% TX Medicaid Rad fee schedule,$354.51 ,100% TX Medicaid Rad fee schedule,$354.51 ,100% TX Medicaid Rad fee schedule,$354.51 ,100% TX Medicaid Rad fee schedule,$354.51 ,100% TX Medicaid Rad fee schedule,$354.51 ,100% TX Medicaid Rad fee schedule,$270.52 ,"$3,741.30 ","$1,662.80 "
Outpatient Medical Services,RADIOLOGY,74185,MRI ANGIO OF ABDOMEN W OR W/O,610,"$2,539.00 ",$725.00 ,CASE RATE,"$1,955.03 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$1,574.33 ",494% BCBSTX Hitech Rad fee schedule,"$1,641.25 ",515% BCBSTX Hitech Rad fee schedule,"$1,641.25 ",515% BCBSTX Hitech Rad fee schedule,"$1,641.25 ",515% BCBSTX Hitech Rad fee schedule,"$2,285.10 ",90% of total billed charges,"$2,031.20 ",80% of total billed charges,"$2,285.10 ",90% of total billed charges,"$1,904.25 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$1,701.13 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$2,031.20 ",80% of total billed charges,"$1,650.35 ",65% of total billed charges,$905.66 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$736.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$725.00 ,"$2,285.10 ","$1,015.60 "
Outpatient Medical Services,RADIOLOGY,77046,MRI BREAST W/O CONTRAST RIGHT,610,"$2,979.00 ",$725.00 ,CASE RATE,"$2,293.83 ",77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,"$1,138.97 ",494% BCBSTX Hitech Rad fee schedule,"$1,187.38 ",515% BCBSTX Hitech Rad fee schedule,"$1,187.38 ",515% BCBSTX Hitech Rad fee schedule,"$1,187.38 ",515% BCBSTX Hitech Rad fee schedule,"$2,681.10 ",90% of total billed charges,"$2,383.20 ",80% of total billed charges,"$2,681.10 ",90% of total billed charges,"$2,234.25 ",75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$214.33 ,100% of Medicare outpatient rates,"$1,995.93 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$171.46 ,80% of Medicare outpatient rates,"$2,383.20 ",80% of total billed charges,"$1,936.35 ",65% of total billed charges,"$1,062.61 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$863.91 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$171.46 ,"$2,681.10 ","$1,191.60 "
Outpatient Medical Services,RADIOLOGY,77048,MRI BREAST W/WO CONTRAST LEFT,610,"$3,576.00 ",$725.00 ,CASE RATE,"$2,753.52 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$1,448.46 ",494% BCBSTX Hitech Rad fee schedule,"$1,510.03 ",515% BCBSTX Hitech Rad fee schedule,"$1,510.03 ",515% BCBSTX Hitech Rad fee schedule,"$1,510.03 ",515% BCBSTX Hitech Rad fee schedule,"$3,218.40 ",90% of total billed charges,"$2,860.80 ",80% of total billed charges,"$3,218.40 ",90% of total billed charges,"$2,682.00 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$2,395.92 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$2,860.80 ",80% of total billed charges,"$2,324.40 ",65% of total billed charges,"$1,275.56 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,037.04 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$725.00 ,"$3,218.40 ","$1,430.40 "
Outpatient Medical Services,RADIOLOGY,93880,CAROTID DUPLEX,921,"$1,107.00 ",$940.95 ,85% of total billed charges,$852.39 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$506.52 ,429% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$996.30 ,90% of total billed charges,$885.60 ,80% of total billed charges,$996.30 ,90% of total billed charges,$830.25 ,75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$195.46 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$741.69 ,67% of total billed charges,$141.80 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,$885.60 ,80% of total billed charges,$719.55 ,65% of total billed charges,$240.42 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$195.46 ,100% TX Medicaid Rad fee schedule,$195.46 ,100% TX Medicaid Rad fee schedule,$195.46 ,100% TX Medicaid Rad fee schedule,$195.46 ,100% TX Medicaid Rad fee schedule,$195.46 ,100% TX Medicaid Rad fee schedule,$195.46 ,100% TX Medicaid Rad fee schedule,$141.80 ,$996.30 ,$442.80 
Outpatient Medical Services,RADIOLOGY,93922,US ANKLE BRACHIAL INDEX TEST,921,$519.00 ,$441.15 ,85% of total billed charges,$399.63 ,77% of total billed charges,$106.57 ,100% of Medicare outpatient rates,$450.62 ,429% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$469.53 ,447% BCBSTX Other fee schedule,$467.10 ,90% of total billed charges,$415.20 ,80% of total billed charges,$467.10 ,90% of total billed charges,$389.25 ,75% of total billed charges,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$130.01 ,100% of Medicare outpatient rates,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$347.73 ,67% of total billed charges,$60.95 ,105% of 2012 Medicare outpatient rates,$85.25 ,80% of Medicare outpatient rates,$415.20 ,80% of total billed charges,$337.35 ,65% of total billed charges,$185.13 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$106.57 ,100% of Medicare outpatient rates,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$150.51 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$60.95 ,$469.53 ,$207.60 
Outpatient Medical Services,RADIOLOGY,93923,DIGITAL PRESSURES,921,$668.00 ,$567.80 ,85% of total billed charges,$514.36 ,77% of total billed charges,$133.47 ,100% of Medicare outpatient rates,$501.93 ,429% BCBSTX Other fee schedule,$522.99 ,447% BCBSTX Other fee schedule,$522.99 ,447% BCBSTX Other fee schedule,$522.99 ,447% BCBSTX Other fee schedule,$601.20 ,90% of total billed charges,$534.40 ,80% of total billed charges,$601.20 ,90% of total billed charges,$501.00 ,75% of total billed charges,$162.84 ,100% of Medicare outpatient rates,$162.84 ,100% of Medicare outpatient rates,$162.84 ,100% of Medicare outpatient rates,$129.31 ,100% TX Medicaid Rad fee schedule,$133.47 ,100% of Medicare outpatient rates,$447.56 ,67% of total billed charges,$99.41 ,105% of 2012 Medicare outpatient rates,$106.78 ,80% of Medicare outpatient rates,$534.40 ,80% of total billed charges,$434.20 ,65% of total billed charges,$159.05 ,123% TX Medicaid Rad fee schedule,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$129.31 ,100% TX Medicaid Rad fee schedule,$129.31 ,100% TX Medicaid Rad fee schedule,$129.31 ,100% TX Medicaid Rad fee schedule,$129.31 ,100% TX Medicaid Rad fee schedule,$129.31 ,100% TX Medicaid Rad fee schedule,$129.31 ,100% TX Medicaid Rad fee schedule,$99.41 ,$601.20 ,$267.20 
Outpatient Medical Services,RADIOLOGY,93924,POST EXERCISE STRESS TEST,921,$733.00 ,$623.05 ,85% of total billed charges,$564.41 ,77% of total billed charges,$257.05 ,100% of Medicare outpatient rates,$637.41 ,429% BCBSTX Other fee schedule,$664.15 ,447% BCBSTX Other fee schedule,$664.15 ,447% BCBSTX Other fee schedule,$664.15 ,447% BCBSTX Other fee schedule,$659.70 ,90% of total billed charges,$586.40 ,80% of total billed charges,$659.70 ,90% of total billed charges,$549.75 ,75% of total billed charges,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$160.39 ,100% TX Medicaid Rad fee schedule,$257.05 ,100% of Medicare outpatient rates,$491.11 ,67% of total billed charges,$99.41 ,105% of 2012 Medicare outpatient rates,$205.63 ,80% of Medicare outpatient rates,$586.40 ,80% of total billed charges,$476.45 ,65% of total billed charges,$197.28 ,123% TX Medicaid Rad fee schedule,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$160.39 ,100% TX Medicaid Rad fee schedule,$160.39 ,100% TX Medicaid Rad fee schedule,$160.39 ,100% TX Medicaid Rad fee schedule,$160.39 ,100% TX Medicaid Rad fee schedule,$160.39 ,100% TX Medicaid Rad fee schedule,$160.39 ,100% TX Medicaid Rad fee schedule,$99.41 ,$664.15 ,$293.20 
Outpatient Medical Services,RADIOLOGY,93925,ARTERIAL DUPLEX LOW EXT BI,921,"$1,141.00 ",$969.85 ,85% of total billed charges,$878.57 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$973.06 ,429% BCBSTX Other fee schedule,"$1,013.89 ",447% BCBSTX Other fee schedule,"$1,013.89 ",447% BCBSTX Other fee schedule,"$1,013.89 ",447% BCBSTX Other fee schedule,"$1,026.90 ",90% of total billed charges,$912.80 ,80% of total billed charges,"$1,026.90 ",90% of total billed charges,$855.75 ,75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$230.13 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$764.47 ,67% of total billed charges,$141.80 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,$912.80 ,80% of total billed charges,$741.65 ,65% of total billed charges,$283.06 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$230.13 ,100% TX Medicaid Rad fee schedule,$230.13 ,100% TX Medicaid Rad fee schedule,$230.13 ,100% TX Medicaid Rad fee schedule,$230.13 ,100% TX Medicaid Rad fee schedule,$230.13 ,100% TX Medicaid Rad fee schedule,$230.13 ,100% TX Medicaid Rad fee schedule,$141.80 ,"$1,026.90 ",$456.40 
Outpatient Medical Services,RADIOLOGY,93926,ARTERIAL DUPLEX LOW EXT UNI,921,$596.00 ,$506.60 ,85% of total billed charges,$458.92 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$508.06 ,429% BCBSTX Other fee schedule,$529.38 ,447% BCBSTX Other fee schedule,$529.38 ,447% BCBSTX Other fee schedule,$529.38 ,447% BCBSTX Other fee schedule,$536.40 ,90% of total billed charges,$476.80 ,80% of total billed charges,$536.40 ,90% of total billed charges,$447.00 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$399.32 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$476.80 ,80% of total billed charges,$387.40 ,65% of total billed charges,$134.03 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$78.47 ,$536.40 ,$238.40 
Outpatient Medical Services,RADIOLOGY,93930,ARTERIAL DUPLEX UPPER EXT BI,921,"$1,060.00 ",$901.00 ,85% of total billed charges,$816.20 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$506.52 ,429% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$527.77 ,447% BCBSTX Other fee schedule,$954.00 ,90% of total billed charges,$848.00 ,80% of total billed charges,$954.00 ,90% of total billed charges,$795.00 ,75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$202.15 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$710.20 ,67% of total billed charges,$141.80 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,$848.00 ,80% of total billed charges,$689.00 ,65% of total billed charges,$248.64 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$202.15 ,100% TX Medicaid Rad fee schedule,$202.15 ,100% TX Medicaid Rad fee schedule,$202.15 ,100% TX Medicaid Rad fee schedule,$202.15 ,100% TX Medicaid Rad fee schedule,$202.15 ,100% TX Medicaid Rad fee schedule,$202.15 ,100% TX Medicaid Rad fee schedule,$141.80 ,$954.00 ,$424.00 
Outpatient Medical Services,RADIOLOGY,93931,ARTERIAL DUPLEX UPPER EXT UNI,921,$734.00 ,$623.90 ,85% of total billed charges,$565.18 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$463.41 ,429% BCBSTX Other fee schedule,$482.85 ,447% BCBSTX Other fee schedule,$482.85 ,447% BCBSTX Other fee schedule,$482.85 ,447% BCBSTX Other fee schedule,$660.60 ,90% of total billed charges,$587.20 ,80% of total billed charges,$660.60 ,90% of total billed charges,$550.50 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$491.78 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$587.20 ,80% of total billed charges,$477.10 ,65% of total billed charges,$134.03 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$78.47 ,$660.60 ,$293.60 
Outpatient Medical Services,RADIOLOGY,93970,ULTRASOUND VEN. EXT BIL,921,"$1,247.00 ","$1,059.95 ",85% of total billed charges,$960.19 ,77% of total billed charges,$214.33 ,100% of Medicare outpatient rates,$712.83 ,429% BCBSTX Other fee schedule,$742.74 ,447% BCBSTX Other fee schedule,$742.74 ,447% BCBSTX Other fee schedule,$742.74 ,447% BCBSTX Other fee schedule,"$1,122.30 ",90% of total billed charges,$997.60 ,80% of total billed charges,"$1,122.30 ",90% of total billed charges,$935.25 ,75% of total billed charges,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$261.48 ,100% of Medicare outpatient rates,$191.79 ,100% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$835.49 ,67% of total billed charges,$141.80 ,105% of 2012 Medicare outpatient rates,$171.46 ,80% of Medicare outpatient rates,$997.60 ,80% of total billed charges,$810.55 ,65% of total billed charges,$235.90 ,123% TX Medicaid Rad fee schedule,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$214.33 ,100% of Medicare outpatient rates,$191.79 ,100% TX Medicaid Rad fee schedule,$191.79 ,100% TX Medicaid Rad fee schedule,$191.79 ,100% TX Medicaid Rad fee schedule,$191.79 ,100% TX Medicaid Rad fee schedule,$191.79 ,100% TX Medicaid Rad fee schedule,$191.79 ,100% TX Medicaid Rad fee schedule,$141.80 ,"$1,122.30 ",$498.80 
Outpatient Medical Services,RADIOLOGY,93971,US VEN EXT UNI,921,$867.00 ,$736.95 ,85% of total billed charges,$667.59 ,77% of total billed charges,$98.10 ,100% of Medicare outpatient rates,$431.10 ,429% BCBSTX Other fee schedule,$449.19 ,447% BCBSTX Other fee schedule,$449.19 ,447% BCBSTX Other fee schedule,$449.19 ,447% BCBSTX Other fee schedule,$780.30 ,90% of total billed charges,$693.60 ,80% of total billed charges,$780.30 ,90% of total billed charges,$650.25 ,75% of total billed charges,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$119.68 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$580.89 ,67% of total billed charges,$89.76 ,105% of 2012 Medicare outpatient rates,$78.47 ,80% of Medicare outpatient rates,$693.60 ,80% of total billed charges,$563.55 ,65% of total billed charges,$134.03 ,123% TX Medicaid Rad fee schedule,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$98.10 ,100% of Medicare outpatient rates,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$108.97 ,100% TX Medicaid Rad fee schedule,$78.47 ,$780.30 ,$346.80 
Outpatient Medical Services,SLEEP STUDIES,95810,Sleep study,740,"$3,138.00 ","$2,667.30 ",85% of total billed charges,"$2,416.26 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$2,200.13 ",429% BCBSTX Other fee schedule,"$2,292.44 ",447% BCBSTX Other fee schedule,"$2,292.44 ",447% BCBSTX Other fee schedule,"$2,292.44 ",447% BCBSTX Other fee schedule,"$2,824.20 ",90% of total billed charges,"$2,510.40 ",80% of total billed charges,"$2,824.20 ",90% of total billed charges,"$2,353.50 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,102.46 ",67% of total billed charges,$740.68 ,105% of 2012 Medicare outpatient rates,$686.10 ,80% of Medicare outpatient rates,"$2,510.40 ",80% of total billed charges,"$2,039.70 ",65% of total billed charges,"$1,119.32 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$910.02 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$2,824.20 ","$1,255.20 "
Outpatient Medical Services,SLEEP STUDIES,95812,EEG MON ROUTINE UP TO 60 MIN,740,"$1,266.00 ","$1,076.10 ",85% of total billed charges,$974.82 ,77% of total billed charges,$257.05 ,100% of Medicare outpatient rates,"$1,156.24 ",429% BCBSTX Other fee schedule,"$1,204.75 ",447% BCBSTX Other fee schedule,"$1,204.75 ",447% BCBSTX Other fee schedule,"$1,204.75 ",447% BCBSTX Other fee schedule,"$1,139.40 ",90% of total billed charges,"$1,012.80 ",80% of total billed charges,"$1,139.40 ",90% of total billed charges,$949.50 ,75% of total billed charges,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$848.22 ,67% of total billed charges,$158.53 ,105% of 2012 Medicare outpatient rates,$205.63 ,80% of Medicare outpatient rates,"$1,012.80 ",80% of total billed charges,$822.90 ,65% of total billed charges,$451.58 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$367.14 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.53 ,"$1,204.75 ",$506.40 
Outpatient Medical Services,SLEEP STUDIES,95813,EEG ROUTINE MONITOR + 60 MIN,740,"$1,525.00 ","$1,296.25 ",85% of total billed charges,"$1,174.25 ",77% of total billed charges,$257.05 ,100% of Medicare outpatient rates,"$1,391.80 ",429% BCBSTX Other fee schedule,"$1,450.20 ",447% BCBSTX Other fee schedule,"$1,450.20 ",447% BCBSTX Other fee schedule,"$1,450.20 ",447% BCBSTX Other fee schedule,"$1,372.50 ",90% of total billed charges,"$1,220.00 ",80% of total billed charges,"$1,372.50 ",90% of total billed charges,"$1,143.75 ",75% of total billed charges,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,"$1,021.75 ",67% of total billed charges,$158.53 ,105% of 2012 Medicare outpatient rates,$205.63 ,80% of Medicare outpatient rates,"$1,220.00 ",80% of total billed charges,$991.25 ,65% of total billed charges,$543.97 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$442.25 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.53 ,"$1,450.20 ",$610.00 
Outpatient Medical Services,SLEEP STUDIES,95782,COMPLEX POLYSOMNOGRAPHY <6 YRS,740,"$3,777.00 ","$3,210.45 ",85% of total billed charges,"$2,908.29 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$3,448.77 ",429% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,399.30 ",90% of total billed charges,"$3,021.60 ",80% of total billed charges,"$3,399.30 ",90% of total billed charges,"$2,832.75 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,530.59 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$686.10 ,80% of Medicare outpatient rates,"$3,021.60 ",80% of total billed charges,"$2,455.05 ",65% of total billed charges,"$1,347.26 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$3,593.48 ","$1,510.80 "
Outpatient Medical Services,SLEEP STUDIES,95783,COMPLETE POLY W/CPAP <6YRS OLD,740,"$4,016.00 ","$3,413.60 ",85% of total billed charges,"$3,092.32 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$3,665.85 ",429% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,614.40 ",90% of total billed charges,"$3,212.80 ",80% of total billed charges,"$3,614.40 ",90% of total billed charges,"$3,012.00 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,690.72 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$686.10 ,80% of Medicare outpatient rates,"$3,212.80 ",80% of total billed charges,"$2,610.40 ",65% of total billed charges,"$1,432.51 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$3,819.66 ","$1,606.40 "
Outpatient Medical Services,SLEEP STUDIES,95805,MULTIPLE SLEEP LATENCY TEST,740,"$1,870.00 ","$1,589.50 ",85% of total billed charges,"$1,439.90 ",77% of total billed charges,$443.72 ,100% of Medicare outpatient rates,"$1,625.82 ",429% BCBSTX Other fee schedule,"$1,694.04 ",447% BCBSTX Other fee schedule,"$1,694.04 ",447% BCBSTX Other fee schedule,"$1,694.04 ",447% BCBSTX Other fee schedule,"$1,683.00 ",90% of total billed charges,"$1,496.00 ",80% of total billed charges,"$1,683.00 ",90% of total billed charges,"$1,402.50 ",75% of total billed charges,$541.33 ,100% of Medicare outpatient rates,$541.33 ,100% of Medicare outpatient rates,$541.33 ,100% of Medicare outpatient rates,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$443.72 ,100% of Medicare outpatient rates,"$1,252.90 ",67% of total billed charges,$740.68 ,105% of 2012 Medicare outpatient rates,$354.97 ,80% of Medicare outpatient rates,"$1,496.00 ",80% of total billed charges,"$1,215.50 ",65% of total billed charges,$667.03 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$542.30 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$354.97 ,"$1,694.04 ",$748.00 
Outpatient Medical Services,SLEEP STUDIES,95806,HOME SLEEP STUDY UNATTENDED,740,$653.00 ,$555.05 ,85% of total billed charges,$502.81 ,77% of total billed charges,$133.47 ,100% of Medicare outpatient rates,$474.22 ,429% BCBSTX Other fee schedule,$494.11 ,447% BCBSTX Other fee schedule,$494.11 ,447% BCBSTX Other fee schedule,$494.11 ,447% BCBSTX Other fee schedule,$587.70 ,90% of total billed charges,$522.40 ,80% of total billed charges,$587.70 ,90% of total billed charges,$489.75 ,75% of total billed charges,$162.84 ,100% of Medicare outpatient rates,$162.84 ,100% of Medicare outpatient rates,$162.84 ,100% of Medicare outpatient rates,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$133.47 ,100% of Medicare outpatient rates,$437.51 ,67% of total billed charges,$158.53 ,105% of 2012 Medicare outpatient rates,$106.78 ,80% of Medicare outpatient rates,$522.40 ,80% of total billed charges,$424.45 ,65% of total billed charges,$232.93 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$133.47 ,100% of Medicare outpatient rates,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$189.37 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.78 ,$587.70 ,$261.20 
Outpatient Medical Services,SLEEP STUDIES,95807,3 CHANNEL SLEEP STUDY,740,"$1,902.00 ","$1,616.70 ",85% of total billed charges,"$1,464.54 ",77% of total billed charges,$443.72 ,100% of Medicare outpatient rates,"$1,736.68 ",429% BCBSTX Other fee schedule,"$1,809.55 ",447% BCBSTX Other fee schedule,"$1,809.55 ",447% BCBSTX Other fee schedule,"$1,809.55 ",447% BCBSTX Other fee schedule,"$1,711.80 ",90% of total billed charges,"$1,521.60 ",80% of total billed charges,"$1,711.80 ",90% of total billed charges,"$1,426.50 ",75% of total billed charges,$541.33 ,100% of Medicare outpatient rates,$541.33 ,100% of Medicare outpatient rates,$541.33 ,100% of Medicare outpatient rates,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$443.72 ,100% of Medicare outpatient rates,"$1,274.34 ",67% of total billed charges,$740.68 ,105% of 2012 Medicare outpatient rates,$354.97 ,80% of Medicare outpatient rates,"$1,521.60 ",80% of total billed charges,"$1,236.30 ",65% of total billed charges,$678.44 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$443.72 ,100% of Medicare outpatient rates,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$551.58 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$354.97 ,"$1,809.55 ",$760.80 
Outpatient Medical Services,SLEEP STUDIES,95811,COMPLETE POLY W/CPAP,740,"$3,470.00 ","$2,949.50 ",85% of total billed charges,"$2,671.90 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$2,315.61 ",429% BCBSTX Other fee schedule,"$2,412.77 ",447% BCBSTX Other fee schedule,"$2,412.77 ",447% BCBSTX Other fee schedule,"$2,412.77 ",447% BCBSTX Other fee schedule,"$3,123.00 ",90% of total billed charges,"$2,776.00 ",80% of total billed charges,"$3,123.00 ",90% of total billed charges,"$2,602.50 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,324.90 ",67% of total billed charges,$740.68 ,105% of 2012 Medicare outpatient rates,$686.10 ,80% of Medicare outpatient rates,"$2,776.00 ",80% of total billed charges,"$2,255.50 ",65% of total billed charges,"$1,237.75 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,006.30 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$3,123.00 ","$1,388.00 "
Outpatient Medical Services,SLEEP STUDIES,95816,ELECTROENCEPHALOGRAM - EEG,740,"$1,492.00 ","$1,268.20 ",85% of total billed charges,"$1,148.84 ",77% of total billed charges,$257.05 ,100% of Medicare outpatient rates,"$1,336.38 ",429% BCBSTX Other fee schedule,"$1,392.45 ",447% BCBSTX Other fee schedule,"$1,392.45 ",447% BCBSTX Other fee schedule,"$1,392.45 ",447% BCBSTX Other fee schedule,"$1,342.80 ",90% of total billed charges,"$1,193.60 ",80% of total billed charges,"$1,342.80 ",90% of total billed charges,"$1,119.00 ",75% of total billed charges,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$313.60 ,100% of Medicare outpatient rates,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$999.64 ,67% of total billed charges,$158.53 ,105% of 2012 Medicare outpatient rates,$205.63 ,80% of Medicare outpatient rates,"$1,193.60 ",80% of total billed charges,$969.80 ,65% of total billed charges,$532.20 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$257.05 ,100% of Medicare outpatient rates,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$432.68 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.53 ,"$1,392.45 ",$596.80 
Outpatient Medical Services,SLEEP STUDIES,95782,COMPLEX POLYSOMN <6YRS <7HRS,740,"$3,777.00 ","$3,210.45 ",85% of total billed charges,"$2,908.29 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$3,448.77 ",429% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,593.48 ",447% BCBSTX Other fee schedule,"$3,399.30 ",90% of total billed charges,"$3,021.60 ",80% of total billed charges,"$3,399.30 ",90% of total billed charges,"$2,832.75 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,530.59 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$686.10 ,80% of Medicare outpatient rates,"$3,021.60 ",80% of total billed charges,"$2,455.05 ",65% of total billed charges,"$1,347.26 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,095.33 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$3,593.48 ","$1,510.80 "
Outpatient Medical Services,SLEEP STUDIES,95783,COMPLETE POLY W/CPAP <6YRS<7HR,740,"$4,016.00 ","$3,413.60 ",85% of total billed charges,"$3,092.32 ",77% of total billed charges,$857.63 ,100% of Medicare outpatient rates,"$3,665.85 ",429% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,819.66 ",447% BCBSTX Other fee schedule,"$3,614.40 ",90% of total billed charges,"$3,212.80 ",80% of total billed charges,"$3,614.40 ",90% of total billed charges,"$3,012.00 ",75% of total billed charges,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,046.30 ",100% of Medicare outpatient rates,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,"$2,690.72 ",67% of total billed charges,,Not separately reimbursible per CMS guidelines,$686.10 ,80% of Medicare outpatient rates,"$3,212.80 ",80% of total billed charges,"$2,610.40 ",65% of total billed charges,"$1,432.51 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,$857.63 ,100% of Medicare outpatient rates,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,164.64 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,$686.10 ,"$3,819.66 ","$1,606.40 "
Outpatient Medical Services,SURGICAL,19120,REMOVAL OF BREAST LESION,360,"$1,713.00 ","$1,150.00 ",CASE RATE,"$1,319.01 ",77% of total billed charges,"$3,155.41 ",100% of Medicare outpatient rates,"$12,684.46 ",465% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$13,230.02 ",485% BCBSTX ASC fee schedule rate,"$1,541.70 ",90% of total billed charges,"$1,370.40 ",80% of total billed charges,"$1,541.70 ",90% of total billed charges,"$1,284.75 ",75% of total billed charges,"$3,849.60 ",100% of Medicare outpatient rates,"$3,849.60 ",100% of Medicare outpatient rates,"$3,849.60 ",100% of Medicare outpatient rates,$963.66 ,100% TX Medicaid ASC fee schedule,"$3,155.41 ",100% of Medicare outpatient rates,"$1,147.71 ",67% of total billed charges,"$1,663.22 ",105% of 2012 Medicare outpatient rates,"$2,524.33 ",80% of Medicare outpatient rates,"$1,370.40 ",80% of total billed charges,"$1,113.45 ",65% of total billed charges,"$1,185.30 ",123% TX Medicaid ASC fee schedule,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,"$3,155.41 ",100% of Medicare outpatient rates,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,100% TX Medicaid ASC fee schedule,$963.66 ,"$13,230.02 ",$685.20 
Outpatient Medical Services,SURGICAL,43235,EGD DIANOSTIC BRUSH WASH,360,"$1,040.00 ","$1,150.00 ",CASE RATE,$800.80 ,77% of total billed charges,$757.70 ,100% of Medicare outpatient rates,"$3,457.23 ",465% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,$936.00 ,90% of total billed charges,$832.00 ,80% of total billed charges,$936.00 ,90% of total billed charges,$780.00 ,75% of total billed charges,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$696.80 ,67% of total billed charges,$551.11 ,105% of 2012 Medicare outpatient rates,$606.15 ,80% of Medicare outpatient rates,$832.00 ,80% of total billed charges,$676.00 ,65% of total billed charges,$411.99 ,123% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,"$3,605.93 ",$416.00 
Outpatient Medical Services,SURGICAL,43239,EGD BIPSY SINGLE/MULTIPLE,360,"$1,177.00 ","$1,150.00 ",CASE RATE,$906.29 ,77% of total billed charges,$757.70 ,100% of Medicare outpatient rates,"$3,457.23 ",465% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$3,605.93 ",485% BCBSTX ASC fee schedule rate,"$1,059.30 ",90% of total billed charges,$941.60 ,80% of total billed charges,"$1,059.30 ",90% of total billed charges,$882.75 ,75% of total billed charges,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$924.39 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$788.59 ,67% of total billed charges,$551.11 ,105% of 2012 Medicare outpatient rates,$606.15 ,80% of Medicare outpatient rates,$941.60 ,80% of total billed charges,$765.05 ,65% of total billed charges,$411.99 ,123% TX Medicaid ASC fee schedule,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$757.70 ,100% of Medicare outpatient rates,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,100% TX Medicaid ASC fee schedule,$334.95 ,"$3,605.93 ",$470.80 
Outpatient Medical Services,SURGICAL,45378,DIANOSTIC COLONSCOPY,360,"$1,326.00 ","$1,150.00 ",CASE RATE,"$1,021.02 ",77% of total billed charges,$762.77 ,100% of Medicare outpatient rates,"$3,301.41 ",465% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$3,443.40 ",485% BCBSTX ASC fee schedule rate,"$1,193.40 ",90% of total billed charges,"$1,060.80 ",80% of total billed charges,"$1,193.40 ",90% of total billed charges,$994.50 ,75% of total billed charges,$930.58 ,100% of Medicare outpatient rates,$930.58 ,100% of Medicare outpatient rates,$930.58 ,100% of Medicare outpatient rates,$328.50 ,100% TX Medicaid ASC fee schedule,$762.77 ,100% of Medicare outpatient rates,$888.42 ,67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$610.22 ,80% of Medicare outpatient rates,"$1,060.80 ",80% of total billed charges,$861.90 ,65% of total billed charges,$404.06 ,123% TX Medicaid ASC fee schedule,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$762.77 ,100% of Medicare outpatient rates,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,100% TX Medicaid ASC fee schedule,$328.50 ,"$3,443.40 ",$530.40 
Outpatient Medical Services,SURGICAL,45380,COLONOSCOPY AND BIOPSY,360,"$1,404.00 ","$1,150.00 ",CASE RATE,"$1,081.08 ",77% of total billed charges,$993.96 ,100% of Medicare outpatient rates,"$4,354.21 ",465% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$1,263.60 ",90% of total billed charges,"$1,123.20 ",80% of total billed charges,"$1,263.60 ",90% of total billed charges,"$1,053.00 ",75% of total billed charges,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,$940.68 ,67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$795.16 ,80% of Medicare outpatient rates,"$1,123.20 ",80% of total billed charges,$912.60 ,65% of total billed charges,$527.99 ,123% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,"$4,541.49 ",$561.60 
Outpatient Medical Services,SURGICAL,45385,COLONOSCOPY W/LESION REMOVAL,360,"$1,780.00 ","$1,150.00 ",CASE RATE,"$1,370.60 ",77% of total billed charges,$993.96 ,100% of Medicare outpatient rates,"$4,354.21 ",465% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$4,541.49 ",485% BCBSTX ASC fee schedule rate,"$1,602.00 ",90% of total billed charges,"$1,424.00 ",80% of total billed charges,"$1,602.00 ",90% of total billed charges,"$1,335.00 ",75% of total billed charges,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,"$1,212.63 ",100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,"$1,192.60 ",67% of total billed charges,$610.87 ,105% of 2012 Medicare outpatient rates,$795.16 ,80% of Medicare outpatient rates,"$1,424.00 ",80% of total billed charges,"$1,157.00 ",65% of total billed charges,$527.99 ,123% TX Medicaid ASC fee schedule,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$993.96 ,100% of Medicare outpatient rates,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,100% TX Medicaid ASC fee schedule,$429.26 ,"$4,541.49 ",$712.00 
Outpatient Medical Services,SURGICAL,47562,LAPAROSCOPIC CHOLESYSTECTOMY,360,"$3,985.00 ","$2,000.00 ",CASE RATE,"$3,068.45 ",77% of total billed charges,"$4,784.01 ",100% of Medicare outpatient rates,"$20,872.36 ",465% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$3,586.50 ",90% of total billed charges,"$3,188.00 ",80% of total billed charges,"$3,586.50 ",90% of total billed charges,"$2,988.75 ",75% of total billed charges,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,"$2,669.95 ",67% of total billed charges,"$3,130.63 ",105% of 2012 Medicare outpatient rates,"$3,827.21 ",80% of Medicare outpatient rates,"$3,188.00 ",80% of total billed charges,"$2,590.25 ",65% of total billed charges,"$2,323.29 ",123% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ","$21,770.10 ","$1,594.00 "
Outpatient Medical Services,SURGICAL,49505,"REPAIR 1ST INGUN HERNIA, AGE 5 OR OLDER, REDUCIBLE",360,"$2,456.00 ","$1,150.00 ",CASE RATE,"$1,891.12 ",77% of total billed charges,"$3,250.99 ",100% of Medicare outpatient rates,"$13,536.89 ",465% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$2,210.40 ",90% of total billed charges,"$1,964.80 ",80% of total billed charges,"$2,210.40 ",90% of total billed charges,"$1,842.00 ",75% of total billed charges,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$1,645.52 ",67% of total billed charges,"$2,147.37 ",105% of 2012 Medicare outpatient rates,"$2,600.79 ",80% of Medicare outpatient rates,"$1,964.80 ",80% of total billed charges,"$1,596.40 ",65% of total billed charges,"$1,416.39 ",123% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,150.00 ","$14,119.13 ",$982.40 
Outpatient Medical Services,SURGICAL,99243,"PATIENT OFFICE CONSULTATION, TYPICALLY 40 MIN",360,$298.00 ,$253.30 ,85% of total billed charges,$229.46 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$415.70 ,429% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$268.20 ,90% of total billed charges,$238.40 ,80% of total billed charges,$268.20 ,90% of total billed charges,$223.50 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$199.66 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.40 ,80% of total billed charges,$193.70 ,65% of total billed charges,$106.30 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,$433.14 ,$119.20 
Outpatient Medical Services,SURGICAL,99244,"PATIENT OFFICE CONSULTATION, TYPICALLY 60 MIN",360,$380.00 ,$323.00 ,85% of total billed charges,$292.60 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$668.21 ,429% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$342.00 ,90% of total billed charges,$304.00 ,80% of total billed charges,$342.00 ,90% of total billed charges,$285.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$254.60 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$304.00 ,80% of total billed charges,$247.00 ,65% of total billed charges,$135.55 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,$696.25 ,$152.00 
Outpatient Medical Services,SURGICAL,49652,"LAPAROSCOPY, SURGIGAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA; REDUCIBLE",360,"$3,740.00 ","$1,150.00 ",CASE RATE,"$2,879.80 ",77% of total billed charges,,Not separately reimbursible per CMS guidelines,"$20,872.36 ",465% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$3,366.00 ",90% of total billed charges,"$2,992.00 ",80% of total billed charges,"$3,366.00 ",90% of total billed charges,"$2,805.00 ",75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,"$2,505.80 ",67% of total billed charges,"$4,666.03 ",105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,"$2,992.00 ",80% of total billed charges,"$2,431.00 ",65% of total billed charges,"$1,334.06 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,084.60 ","$21,770.10 ","$1,496.00 "
Outpatient Medical Services,SURGICAL,19307,"MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE",360,"$3,432.00 ","$1,150.00 ",CASE RATE,"$2,642.64 ",77% of total billed charges,"$5,454.97 ",100% of Medicare outpatient rates,"$22,375.24 ",465% BCBSTX ASC fee schedule rate,"$23,337.62 ",485% BCBSTX ASC fee schedule rate,"$23,337.62 ",485% BCBSTX ASC fee schedule rate,"$23,337.62 ",485% BCBSTX ASC fee schedule rate,"$3,088.80 ",90% of total billed charges,"$2,745.60 ",80% of total billed charges,"$3,088.80 ",90% of total billed charges,"$2,574.00 ",75% of total billed charges,"$6,655.07 ",100% of Medicare outpatient rates,"$6,655.07 ",100% of Medicare outpatient rates,"$6,655.07 ",100% of Medicare outpatient rates,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,"$5,454.97 ",100% of Medicare outpatient rates,"$2,299.44 ",67% of total billed charges,"$2,927.95 ",105% of 2012 Medicare outpatient rates,"$4,363.97 ",80% of Medicare outpatient rates,"$2,745.60 ",80% of total billed charges,"$2,230.80 ",65% of total billed charges,"$1,224.19 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,"$5,454.97 ",100% of Medicare outpatient rates,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$995.28 ,"$23,337.62 ","$1,372.80 "
Outpatient Medical Services,SURGICAL,44140,"COLECTOMY, PARTIAL; WITH ANASTOMOSIS",360,"$4,011.00 ","$1,150.00 ",CASE RATE,"$3,088.47 ",77% of total billed charges,"$4,011.00 ",100% of Medicare outpatient rates,"$6,486.70 ",465% BCBSTX ASC fee schedule rate,"$6,765.70 ",485% BCBSTX ASC fee schedule rate,"$6,765.70 ",485% BCBSTX ASC fee schedule rate,"$6,765.70 ",485% BCBSTX ASC fee schedule rate,"$3,609.90 ",90% of total billed charges,"$3,208.80 ",80% of total billed charges,"$3,609.90 ",90% of total billed charges,"$3,008.25 ",75% of total billed charges,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$4,011.00 ",100% of Medicare outpatient rates,"$2,687.37 ",67% of total billed charges,"$4,011.00 ",105% of 2012 Medicare outpatient rates,"$4,011.00 ",80% of Medicare outpatient rates,"$3,208.80 ",80% of total billed charges,"$2,607.15 ",65% of total billed charges,"$1,430.72 ",35.67% of total billed charges which is 123% of TX Medicaid OP CCR,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$4,011.00 ",100% of Medicare outpatient rates,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,163.19 ",29% of total billed charges which is 100% of TX Medicaid OP CCR,"$1,150.00 ","$6,765.70 ","$1,604.40 "
Outpatient Medical Services,SURGICAL,46260,"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS",360,"$1,872.00 ","$1,150.00 ",CASE RATE,"$1,441.44 ",77% of total billed charges,"$2,358.40 ",100% of Medicare outpatient rates,"$10,767.68 ",465% BCBSTX ASC fee schedule rate,"$11,230.81 ",485% BCBSTX ASC fee schedule rate,"$11,230.81 ",485% BCBSTX ASC fee schedule rate,"$11,230.81 ",485% BCBSTX ASC fee schedule rate,"$1,684.80 ",90% of total billed charges,"$1,497.60 ",80% of total billed charges,"$1,684.80 ",90% of total billed charges,"$1,404.00 ",75% of total billed charges,"$2,877.26 ",100% of Medicare outpatient rates,"$2,877.26 ",100% of Medicare outpatient rates,"$2,877.26 ",100% of Medicare outpatient rates,$939.93 ,100% TX Medicaid ASC fee schedule,"$2,358.40 ",100% of Medicare outpatient rates,"$1,254.24 ",67% of total billed charges,"$1,591.49 ",105% of 2012 Medicare outpatient rates,"$1,886.72 ",80% of Medicare outpatient rates,"$1,497.60 ",80% of total billed charges,"$1,216.80 ",65% of total billed charges,"$1,156.11 ",123% TX Medicaid ASC fee schedule,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,"$2,358.40 ",100% of Medicare outpatient rates,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,100% TX Medicaid ASC fee schedule,$939.93 ,"$11,230.81 ",$748.80 
Outpatient Medical Services,SURGICAL,49650,"LAPARASCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA",360,"$1,296.00 ","$1,150.00 ",CASE RATE,$997.92 ,77% of total billed charges,"$4,784.01 ",100% of Medicare outpatient rates,"$20,872.36 ",465% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$1,166.40 ",90% of total billed charges,"$1,036.80 ",80% of total billed charges,"$1,166.40 ",90% of total billed charges,$972.00 ,75% of total billed charges,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,$868.32 ,67% of total billed charges,"$3,130.63 ",105% of 2012 Medicare outpatient rates,"$3,827.21 ",80% of Medicare outpatient rates,"$1,036.80 ",80% of total billed charges,$842.40 ,65% of total billed charges,"$2,323.29 ",123% TX Medicaid ASC fee schedule,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,"$1,888.85 ",100% TX Medicaid ASC fee schedule,$842.40 ,"$21,770.10 ",$518.40 
Outpatient Medical Services,SURGICAL,49505,"REPAIR INITIAL INGUINAL HERNIA; AGE 5 YEARS OR OLDER, REDUCIBLE",360,"$2,456.00 ","$1,150.00 ",CASE RATE,"$1,891.12 ",77% of total billed charges,"$3,250.99 ",100% of Medicare outpatient rates,"$13,536.89 ",465% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$14,119.13 ",485% BCBSTX ASC fee schedule rate,"$2,210.40 ",90% of total billed charges,"$1,964.80 ",80% of total billed charges,"$2,210.40 ",90% of total billed charges,"$1,842.00 ",75% of total billed charges,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$3,966.21 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$1,645.52 ",67% of total billed charges,"$2,147.37 ",105% of 2012 Medicare outpatient rates,"$2,600.79 ",80% of Medicare outpatient rates,"$1,964.80 ",80% of total billed charges,"$1,596.40 ",65% of total billed charges,"$1,416.39 ",123% TX Medicaid ASC fee schedule,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$3,250.99 ",100% of Medicare outpatient rates,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,151.54 ",100% TX Medicaid ASC fee schedule,"$1,150.00 ","$14,119.13 ",$982.40 
Outpatient Medical Services,SURGICAL,44970,"LAPARASCOPY, SURGICAL; APPENDECTOMY",360,"$2,648.00 ","$1,150.00 ",CASE RATE,"$2,038.96 ",77% of total billed charges,"$4,784.01 ",100% of Medicare outpatient rates,"$20,872.36 ",465% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$21,770.10 ",485% BCBSTX ASC fee schedule rate,"$2,383.20 ",90% of total billed charges,"$2,118.40 ",80% of total billed charges,"$2,383.20 ",90% of total billed charges,"$1,986.00 ",75% of total billed charges,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,"$5,836.50 ",100% of Medicare outpatient rates,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,"$4,784.01 ",100% of Medicare outpatient rates,"$1,774.16 ",67% of total billed charges,"$3,130.63 ",105% of 2012 Medicare outpatient rates,"$3,827.21 ",80% of Medicare outpatient rates,"$2,118.40 ",80% of total billed charges,"$1,721.20 ",65% of total billed charges,$944.54 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,"$4,784.01 ",100% of Medicare outpatient rates,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$767.92 ,"$21,770.10 ","$1,059.20 "
Outpatient Medical Services,SURGICAL,11750,"EXCISION OF NAIL AND NAIL MATRIX,PARTIAL OR COMPLETE, FOR PERMANENT REMOVAL",360,$364.00 ,"$1,150.00 ",CASE RATE,$280.28 ,77% of total billed charges,$342.42 ,100% of Medicare outpatient rates,$446.96 ,465% BCBSTX ASC fee schedule rate,$466.18 ,485% BCBSTX ASC fee schedule rate,$466.18 ,485% BCBSTX ASC fee schedule rate,$466.18 ,485% BCBSTX ASC fee schedule rate,$327.60 ,90% of total billed charges,$291.20 ,80% of total billed charges,$327.60 ,90% of total billed charges,$273.00 ,75% of total billed charges,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$84.71 ,100% TX Medicaid ASC fee schedule,$342.42 ,100% of Medicare outpatient rates,$243.88 ,67% of total billed charges,$288.47 ,105% of 2012 Medicare outpatient rates,$273.93 ,80% of Medicare outpatient rates,$291.20 ,80% of total billed charges,$236.60 ,65% of total billed charges,$104.19 ,123% TX Medicaid ASC fee schedule,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,100% TX Medicaid ASC fee schedule,$84.71 ,"$1,150.00 ",$145.60 
Outpatient Medical Services,SURGICAL,28122,"PARTIAL EXCISION BONE; TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS",360,"$1,341.00 ","$1,150.00 ",CASE RATE,"$1,032.57 ",77% of total billed charges,"$2,732.15 ",100% of Medicare outpatient rates,"$12,300.32 ",465% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$12,829.37 ",485% BCBSTX ASC fee schedule rate,"$1,206.90 ",90% of total billed charges,"$1,072.80 ",80% of total billed charges,"$1,206.90 ",90% of total billed charges,"$1,005.75 ",75% of total billed charges,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,$898.47 ,67% of total billed charges,"$1,441.42 ",105% of 2012 Medicare outpatient rates,"$2,185.71 ",80% of Medicare outpatient rates,"$1,072.80 ",80% of total billed charges,$871.65 ,65% of total billed charges,"$1,338.57 ",123% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,$871.65 ,"$12,829.37 ",$536.40 
Outpatient Medical Services,SURGICAL,28820,"AMPUTATION, TOE; METATARSOPHALANGEAL JOINT",360,"$1,092.00 ","$1,150.00 ",CASE RATE,$840.84 ,77% of total billed charges,"$2,732.15 ",100% of Medicare outpatient rates,"$6,277.22 ",465% BCBSTX ASC fee schedule rate,"$6,547.21 ",485% BCBSTX ASC fee schedule rate,"$6,547.21 ",485% BCBSTX ASC fee schedule rate,"$6,547.21 ",485% BCBSTX ASC fee schedule rate,$982.80 ,90% of total billed charges,$873.60 ,80% of total billed charges,$982.80 ,90% of total billed charges,$819.00 ,75% of total billed charges,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,$731.64 ,67% of total billed charges,"$1,441.42 ",105% of 2012 Medicare outpatient rates,"$2,185.71 ",80% of Medicare outpatient rates,$873.60 ,80% of total billed charges,$709.80 ,65% of total billed charges,"$1,338.57 ",123% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,"$1,088.27 ",100% TX Medicaid ASC fee schedule,$709.80 ,"$6,547.21 ",$436.80 
Outpatient Medical Services,SURGICAL,28232,"TENOTOMY, OPEN, FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)",360,$600.00 ,"$1,150.00 ",CASE RATE,$462.00 ,77% of total billed charges,"$1,316.68 ",100% of Medicare outpatient rates,"$1,237.09 ",465% BCBSTX ASC fee schedule rate,"$1,290.29 ",485% BCBSTX ASC fee schedule rate,"$1,290.29 ",485% BCBSTX ASC fee schedule rate,"$1,290.29 ",485% BCBSTX ASC fee schedule rate,$540.00 ,90% of total billed charges,$480.00 ,80% of total billed charges,$540.00 ,90% of total billed charges,$450.00 ,75% of total billed charges,"$1,606.35 ",100% of Medicare outpatient rates,"$1,606.35 ",100% of Medicare outpatient rates,"$1,606.35 ",100% of Medicare outpatient rates,$203.76 ,100% TX Medicaid ASC fee schedule,"$1,316.68 ",100% of Medicare outpatient rates,$402.00 ,67% of total billed charges,"$1,441.42 ",105% of 2012 Medicare outpatient rates,"$1,053.33 ",80% of Medicare outpatient rates,$480.00 ,80% of total billed charges,$390.00 ,65% of total billed charges,$250.62 ,123% TX Medicaid ASC fee schedule,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,"$1,316.68 ",100% of Medicare outpatient rates,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,100% TX Medicaid ASC fee schedule,$203.76 ,"$1,606.35 ",$240.00 
Outpatient Medical Services,SURGICAL,28124,PARTIAL EXCISION BONE; PHALANX OF TOE,360,$973.00 ,"$1,150.00 ",CASE RATE,$749.21 ,77% of total billed charges,"$2,732.15 ",100% of Medicare outpatient rates,"$1,409.51 ",465% BCBSTX ASC fee schedule rate,"$1,470.13 ",485% BCBSTX ASC fee schedule rate,"$1,470.13 ",485% BCBSTX ASC fee schedule rate,"$1,470.13 ",485% BCBSTX ASC fee schedule rate,$875.70 ,90% of total billed charges,$778.40 ,80% of total billed charges,$875.70 ,90% of total billed charges,$729.75 ,75% of total billed charges,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,"$3,333.22 ",100% of Medicare outpatient rates,$238.37 ,100% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,$651.91 ,67% of total billed charges,"$1,441.42 ",105% of 2012 Medicare outpatient rates,"$2,185.71 ",80% of Medicare outpatient rates,$778.40 ,80% of total billed charges,$632.45 ,65% of total billed charges,$293.20 ,123% TX Medicaid ASC fee schedule,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,"$2,732.15 ",100% of Medicare outpatient rates,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,100% TX Medicaid ASC fee schedule,$238.37 ,"$3,333.22 ",$389.20 
Outpatient Medical Services,SURGICAL,99212,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10-19 MIN",760,$176.00 ,$149.60 ,85% of total billed charges,$135.52 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$110.85 ,429% BCBSTX Other fee schedule,$115.50 ,447% BCBSTX Other fee schedule,$115.50 ,447% BCBSTX Other fee schedule,$115.50 ,447% BCBSTX Other fee schedule,$158.40 ,90% of total billed charges,$140.80 ,80% of total billed charges,$158.40 ,90% of total billed charges,$132.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$117.92 ,67% of total billed charges,$67.20 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$140.80 ,80% of total billed charges,$114.40 ,65% of total billed charges,$62.78 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.04 ,$158.40 ,$70.40 
Outpatient Medical Services,SURGICAL,99213,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 20-29 MIN",760,$252.00 ,$214.20 ,85% of total billed charges,$194.04 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$223.25 ,429% BCBSTX Other fee schedule,$232.62 ,447% BCBSTX Other fee schedule,$232.62 ,447% BCBSTX Other fee schedule,$232.62 ,447% BCBSTX Other fee schedule,$226.80 ,90% of total billed charges,$201.60 ,80% of total billed charges,$226.80 ,90% of total billed charges,$189.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$168.84 ,67% of total billed charges,$67.20 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$201.60 ,80% of total billed charges,$163.80 ,65% of total billed charges,$89.89 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$73.08 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.20 ,$232.62 ,$100.80 
Outpatient Medical Services,SURGICAL,99214,"ESTABLISHED PATIENT OFFIC EOR OTHER OUTPATIENT VISIT, TYPICALLY 30-39 MIN",760,$375.00 ,$318.75 ,85% of total billed charges,$288.75 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$341.78 ,429% BCBSTX Other fee schedule,$356.12 ,447% BCBSTX Other fee schedule,$356.12 ,447% BCBSTX Other fee schedule,$356.12 ,447% BCBSTX Other fee schedule,$337.50 ,90% of total billed charges,$300.00 ,80% of total billed charges,$337.50 ,90% of total billed charges,$281.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$251.25 ,67% of total billed charges,$88.66 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$300.00 ,80% of total billed charges,$243.75 ,65% of total billed charges,$133.76 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.75 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$88.66 ,$356.12 ,$150.00 
Outpatient Medical Services,SURGICAL,99215,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 40-54 MIN",760,$531.00 ,$451.35 ,85% of total billed charges,$408.87 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$483.44 ,429% BCBSTX Other fee schedule,$503.72 ,447% BCBSTX Other fee schedule,$503.72 ,447% BCBSTX Other fee schedule,$503.72 ,447% BCBSTX Other fee schedule,$477.90 ,90% of total billed charges,$424.80 ,80% of total billed charges,$477.90 ,90% of total billed charges,$398.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$355.77 ,67% of total billed charges,$121.56 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$424.80 ,80% of total billed charges,$345.15 ,65% of total billed charges,$189.41 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$153.99 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.56 ,$503.72 ,$212.40 
Outpatient Medical Services,SURGICAL,99202,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15-29 MIN",760,$242.00 ,$205.70 ,85% of total billed charges,$186.34 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$220.16 ,429% BCBSTX Other fee schedule,$229.40 ,447% BCBSTX Other fee schedule,$229.40 ,447% BCBSTX Other fee schedule,$229.40 ,447% BCBSTX Other fee schedule,$217.80 ,90% of total billed charges,$193.60 ,80% of total billed charges,$217.80 ,90% of total billed charges,$181.50 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$162.14 ,67% of total billed charges,$67.20 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$193.60 ,80% of total billed charges,$157.30 ,65% of total billed charges,$86.32 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$70.18 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.20 ,$229.40 ,$96.80 
Outpatient Medical Services,SURGICAL,99203,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 30-44 MIN",760,$368.00 ,$312.80 ,85% of total billed charges,$283.36 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$334.11 ,429% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$331.20 ,90% of total billed charges,$294.40 ,80% of total billed charges,$331.20 ,90% of total billed charges,$276.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$246.56 ,67% of total billed charges,$88.66 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$294.40 ,80% of total billed charges,$239.20 ,65% of total billed charges,$131.27 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$88.66 ,$348.12 ,$147.20 
Outpatient Medical Services,SURGICAL,99204,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 45-59 MIN",760,$617.00 ,$524.45 ,85% of total billed charges,$475.09 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$563.49 ,429% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$555.30 ,90% of total billed charges,$493.60 ,80% of total billed charges,$555.30 ,90% of total billed charges,$462.75 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$413.39 ,67% of total billed charges,$121.56 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$493.60 ,80% of total billed charges,$401.05 ,65% of total billed charges,$220.08 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.56 ,$587.13 ,$246.80 
Outpatient Medical Services,SURGICAL,99205,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 60-74 MIN",760,$823.00 ,$699.55 ,85% of total billed charges,$633.71 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$735.95 ,429% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$740.70 ,90% of total billed charges,$658.40 ,80% of total billed charges,$740.70 ,90% of total billed charges,$617.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$551.41 ,67% of total billed charges,$164.53 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$658.40 ,80% of total billed charges,$534.95 ,65% of total billed charges,$293.56 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$164.53 ,$766.83 ,$329.20 
Outpatient Medical Services,SURGICAL,99385,INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (18-39 YEARS),760,$180.00 ,$153.00 ,85% of total billed charges,$138.60 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$426.47 ,429% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$162.00 ,90% of total billed charges,$144.00 ,80% of total billed charges,$162.00 ,90% of total billed charges,$135.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$120.60 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$144.00 ,80% of total billed charges,$117.00 ,65% of total billed charges,$64.21 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,$444.36 ,$72.00 
Outpatient Medical Services,SURGICAL,99386,INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS),760,$185.00 ,$157.25 ,85% of total billed charges,$142.45 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$518.83 ,429% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$166.50 ,90% of total billed charges,$148.00 ,80% of total billed charges,$166.50 ,90% of total billed charges,$138.75 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$123.95 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$148.00 ,80% of total billed charges,$120.25 ,65% of total billed charges,$65.99 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,$540.60 ,$74.00 
Outpatient Medical Services,THERAPY,97110,"Physical therapy, therapeutic exercise",420,$90.00 ,$76.50 ,85% of total billed charges,$69.30 ,77% of total billed charges,$29.02 ,100% of Medicare outpatient rates,$133.93 ,429% BCBSTX Other fee schedule,$139.55 ,447% BCBSTX Other fee schedule,$139.55 ,447% BCBSTX Other fee schedule,$139.55 ,447% BCBSTX Other fee schedule,$81.00 ,90% of total billed charges,$72.00 ,80% of total billed charges,$81.00 ,90% of total billed charges,$67.50 ,75% of total billed charges,$35.40 ,100% of Medicare outpatient rates,$35.40 ,100% of Medicare outpatient rates,$35.40 ,100% of Medicare outpatient rates,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$29.02 ,100% of Medicare outpatient rates,$60.30 ,67% of total billed charges,$31.72 ,105% of 2012 Medicare outpatient rates,$23.22 ,80% of Medicare outpatient rates,$72.00 ,80% of total billed charges,$58.50 ,65% of total billed charges,$32.10 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$29.02 ,100% of Medicare outpatient rates,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$26.10 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$23.22 ,$139.55 ,$36.00 
Outpatient Medical Services,THERAPY,97161,PT EVALUATION LOW COMPLEXITY,420,$233.00 ,$198.05 ,85% of total billed charges,$179.41 ,77% of total billed charges,$98.92 ,100% of Medicare outpatient rates,$366.45 ,429% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$209.70 ,90% of total billed charges,$186.40 ,80% of total billed charges,$209.70 ,90% of total billed charges,$174.75 ,75% of total billed charges,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$156.11 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$79.14 ,80% of Medicare outpatient rates,$186.40 ,80% of total billed charges,$151.45 ,65% of total billed charges,$83.11 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$67.57 ,$381.83 ,$93.20 
Outpatient Medical Services,THERAPY,97162,PT EVALUATION MOD COMPLEXITY,420,$303.00 ,$257.55 ,85% of total billed charges,$233.31 ,77% of total billed charges,$98.92 ,100% of Medicare outpatient rates,$366.45 ,429% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$381.83 ,447% BCBSTX Other fee schedule,$272.70 ,90% of total billed charges,$242.40 ,80% of total billed charges,$272.70 ,90% of total billed charges,$227.25 ,75% of total billed charges,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$203.01 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$79.14 ,80% of Medicare outpatient rates,$242.40 ,80% of total billed charges,$196.95 ,65% of total billed charges,$108.08 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.87 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$79.14 ,$381.83 ,$121.20 
Outpatient Medical Services,THERAPY,97165,OCCUPATIONAL THERAPY - LOW COMPLEXITY,430,$434.00 ,$368.90 ,85% of total billed charges,$334.18 ,77% of total billed charges,$98.92 ,100% of Medicare outpatient rates,$395.67 ,429% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$390.60 ,90% of total billed charges,$347.20 ,80% of total billed charges,$390.60 ,90% of total billed charges,$325.50 ,75% of total billed charges,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$290.78 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$79.14 ,80% of Medicare outpatient rates,$347.20 ,80% of total billed charges,$282.10 ,65% of total billed charges,$154.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$79.14 ,$412.27 ,$173.60 
Outpatient Medical Services,THERAPY,97166,OCCUPATIONAL THERAPY - MODERATE COMPLEXITY,430,$434.00 ,$368.90 ,85% of total billed charges,$334.18 ,77% of total billed charges,$98.92 ,100% of Medicare outpatient rates,$395.67 ,429% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$390.60 ,90% of total billed charges,$347.20 ,80% of total billed charges,$390.60 ,90% of total billed charges,$325.50 ,75% of total billed charges,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$290.78 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$79.14 ,80% of Medicare outpatient rates,$347.20 ,80% of total billed charges,$282.10 ,65% of total billed charges,$154.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$79.14 ,$412.27 ,$173.60 
Outpatient Medical Services,THERAPY,97167,OCCUPATIONAL THERAPY - HIGH COMPLEXITY,430,$434.00 ,$368.90 ,85% of total billed charges,$334.18 ,77% of total billed charges,$98.92 ,100% of Medicare outpatient rates,$395.67 ,429% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$412.27 ,447% BCBSTX Other fee schedule,$390.60 ,90% of total billed charges,$347.20 ,80% of total billed charges,$390.60 ,90% of total billed charges,$325.50 ,75% of total billed charges,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$120.68 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$290.78 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$79.14 ,80% of Medicare outpatient rates,$347.20 ,80% of total billed charges,$282.10 ,65% of total billed charges,$154.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$98.92 ,100% of Medicare outpatient rates,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$125.86 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$79.14 ,$412.27 ,$173.60 
Outpatient Medical Services,THERAPY,97607,NEG PRESSURE WND TX 50 CM PTA,420,"$1,462.00 ","$1,242.70 ",85% of total billed charges,"$1,125.74 ",77% of total billed charges,$342.42 ,100% of Medicare outpatient rates,"$1,333.33 ",429% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,315.80 ",90% of total billed charges,"$1,169.60 ",80% of total billed charges,"$1,315.80 ",90% of total billed charges,"$1,096.50 ",75% of total billed charges,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$979.54 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$273.93 ,80% of Medicare outpatient rates,"$1,169.60 ",80% of total billed charges,$950.30 ,65% of total billed charges,$521.50 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$273.93 ,"$1,389.28 ",$584.80 
Outpatient Medical Services,THERAPY,97608,NEG PRESSURE WOUND TX +50 PT,420,"$1,462.00 ","$1,242.70 ",85% of total billed charges,"$1,125.74 ",77% of total billed charges,$342.42 ,100% of Medicare outpatient rates,"$1,333.33 ",429% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,389.28 ",447% BCBSTX Other fee schedule,"$1,315.80 ",90% of total billed charges,"$1,169.60 ",80% of total billed charges,"$1,315.80 ",90% of total billed charges,"$1,096.50 ",75% of total billed charges,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$417.75 ,100% of Medicare outpatient rates,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$979.54 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$273.93 ,80% of Medicare outpatient rates,"$1,169.60 ",80% of total billed charges,$950.30 ,65% of total billed charges,$521.50 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$342.42 ,100% of Medicare outpatient rates,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$423.98 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$273.93 ,"$1,389.28 ",$584.80 
Outpatient Medical Services,THERAPY,92521,SPEECH FLUENCY EVAL,440,$545.00 ,$463.25 ,85% of total billed charges,$419.65 ,77% of total billed charges,$130.89 ,100% of Medicare outpatient rates,$497.30 ,429% BCBSTX Other fee schedule,$518.16 ,447% BCBSTX Other fee schedule,$518.16 ,447% BCBSTX Other fee schedule,$518.16 ,447% BCBSTX Other fee schedule,$490.50 ,90% of total billed charges,$436.00 ,80% of total billed charges,$490.50 ,90% of total billed charges,$408.75 ,75% of total billed charges,$159.69 ,100% of Medicare outpatient rates,$159.69 ,100% of Medicare outpatient rates,$159.69 ,100% of Medicare outpatient rates,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$130.89 ,100% of Medicare outpatient rates,$365.15 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$104.71 ,80% of Medicare outpatient rates,$436.00 ,80% of total billed charges,$354.25 ,65% of total billed charges,$194.40 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$130.89 ,100% of Medicare outpatient rates,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$158.05 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$104.71 ,$518.16 ,$218.00 
Outpatient Medical Services,THERAPY,92522,SPEECH SOUND PRODUCTION EVAL,440,$440.00 ,$374.00 ,85% of total billed charges,$338.80 ,77% of total billed charges,$109.35 ,100% of Medicare outpatient rates,$400.30 ,429% BCBSTX Other fee schedule,$417.10 ,447% BCBSTX Other fee schedule,$417.10 ,447% BCBSTX Other fee schedule,$417.10 ,447% BCBSTX Other fee schedule,$396.00 ,90% of total billed charges,$352.00 ,80% of total billed charges,$396.00 ,90% of total billed charges,$330.00 ,75% of total billed charges,$133.41 ,100% of Medicare outpatient rates,$133.41 ,100% of Medicare outpatient rates,$133.41 ,100% of Medicare outpatient rates,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$109.35 ,100% of Medicare outpatient rates,$294.80 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$87.48 ,80% of Medicare outpatient rates,$352.00 ,80% of total billed charges,$286.00 ,65% of total billed charges,$156.95 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$127.60 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$87.48 ,$417.10 ,$176.00 
Outpatient Medical Services,THERAPY,92523,SPEECH THERAPY EVAL,440,$963.00 ,$818.55 ,85% of total billed charges,$741.51 ,77% of total billed charges,$224.44 ,100% of Medicare outpatient rates,$862.20 ,429% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$898.38 ,447% BCBSTX Other fee schedule,$866.70 ,90% of total billed charges,$770.40 ,80% of total billed charges,$866.70 ,90% of total billed charges,$722.25 ,75% of total billed charges,$273.82 ,100% of Medicare outpatient rates,$273.82 ,100% of Medicare outpatient rates,$273.82 ,100% of Medicare outpatient rates,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$224.44 ,100% of Medicare outpatient rates,$645.21 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$179.55 ,80% of Medicare outpatient rates,$770.40 ,80% of total billed charges,$625.95 ,65% of total billed charges,$343.50 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$224.44 ,100% of Medicare outpatient rates,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$279.27 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$179.55 ,$898.38 ,$385.20 
Outpatient Medical Services,THERAPY,92524,BEHAVIORAL & QUALITATIVE ANALY,440,$420.00 ,$357.00 ,85% of total billed charges,$323.40 ,77% of total billed charges,$108.07 ,100% of Medicare outpatient rates,$383.35 ,429% BCBSTX Other fee schedule,$399.44 ,447% BCBSTX Other fee schedule,$399.44 ,447% BCBSTX Other fee schedule,$399.44 ,447% BCBSTX Other fee schedule,$378.00 ,90% of total billed charges,$336.00 ,80% of total billed charges,$378.00 ,90% of total billed charges,$315.00 ,75% of total billed charges,$131.85 ,100% of Medicare outpatient rates,$131.85 ,100% of Medicare outpatient rates,$131.85 ,100% of Medicare outpatient rates,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$108.07 ,100% of Medicare outpatient rates,$281.40 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$86.46 ,80% of Medicare outpatient rates,$336.00 ,80% of total billed charges,$273.00 ,65% of total billed charges,$149.81 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$108.07 ,100% of Medicare outpatient rates,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.80 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.46 ,$399.44 ,$168.00 
Outpatient Medical Services,THERAPY,92611,SPEECH THERAPY SWALLOWING EVAL,440,$178.00 ,$151.30 ,85% of total billed charges,$137.06 ,77% of total billed charges,$89.63 ,100% of Medicare outpatient rates,$381.81 ,429% BCBSTX Other fee schedule,$397.83 ,447% BCBSTX Other fee schedule,$397.83 ,447% BCBSTX Other fee schedule,$397.83 ,447% BCBSTX Other fee schedule,$160.20 ,90% of total billed charges,$142.40 ,80% of total billed charges,$160.20 ,90% of total billed charges,$133.50 ,75% of total billed charges,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$109.35 ,100% of Medicare outpatient rates,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$89.63 ,100% of Medicare outpatient rates,$119.26 ,67% of total billed charges,$84.74 ,105% of 2012 Medicare outpatient rates,$71.70 ,80% of Medicare outpatient rates,$142.40 ,80% of total billed charges,$115.70 ,65% of total billed charges,$63.49 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$89.63 ,100% of Medicare outpatient rates,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$51.62 ,$397.83 ,$71.20 
Outpatient Medical Services,VISIT CHARGES,90832,"PSYCHOTHERAPY, 30 MIN",760,$197.00 ,$167.45 ,85% of total billed charges,$151.69 ,77% of total billed charges,$133.72 ,100% of Medicare outpatient rates,$161.54 ,82% of total billed charges,$167.45 ,85% of total billed charges,$167.45 ,85% of total billed charges,$167.45 ,85% of total billed charges,$177.30 ,90% of total billed charges,$157.60 ,80% of total billed charges,$177.30 ,90% of total billed charges,$147.75 ,75% of total billed charges,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$131.99 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$106.98 ,80% of Medicare outpatient rates,$157.60 ,80% of total billed charges,$128.05 ,65% of total billed charges,$70.27 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$57.13 ,$177.30 ,$78.80 
Outpatient Medical Services,VISIT CHARGES,90834,"PSYCHOTHERAPY, 45 MIN",760,$239.00 ,$203.15 ,85% of total billed charges,$184.03 ,77% of total billed charges,$133.72 ,100% of Medicare outpatient rates,$195.98 ,82% of total billed charges,$203.15 ,85% of total billed charges,$203.15 ,85% of total billed charges,$203.15 ,85% of total billed charges,$215.10 ,90% of total billed charges,$191.20 ,80% of total billed charges,$215.10 ,90% of total billed charges,$179.25 ,75% of total billed charges,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$160.13 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$106.98 ,80% of Medicare outpatient rates,$191.20 ,80% of total billed charges,$155.35 ,65% of total billed charges,$85.25 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$69.31 ,$215.10 ,$95.60 
Outpatient Medical Services,VISIT CHARGES,90837,"PSYCHOTHERAPY, 60 MIN",760,$318.00 ,$270.30 ,85% of total billed charges,$244.86 ,77% of total billed charges,$133.72 ,100% of Medicare outpatient rates,$260.76 ,82% of total billed charges,$270.30 ,85% of total billed charges,$270.30 ,85% of total billed charges,$270.30 ,85% of total billed charges,$286.20 ,90% of total billed charges,$254.40 ,80% of total billed charges,$286.20 ,90% of total billed charges,$238.50 ,75% of total billed charges,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$163.13 ,100% of Medicare outpatient rates,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$213.06 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,$106.98 ,80% of Medicare outpatient rates,$254.40 ,80% of total billed charges,$206.70 ,65% of total billed charges,$113.43 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$133.72 ,100% of Medicare outpatient rates,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$92.22 ,$286.20 ,$127.20 
Outpatient Medical Services,VISIT CHARGES,99203,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 30 MIN",760,$368.00 ,$312.80 ,85% of total billed charges,$283.36 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$334.11 ,429% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$348.12 ,447% BCBSTX Other fee schedule,$331.20 ,90% of total billed charges,$294.40 ,80% of total billed charges,$331.20 ,90% of total billed charges,$276.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$246.56 ,67% of total billed charges,$88.66 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$294.40 ,80% of total billed charges,$239.20 ,65% of total billed charges,$131.27 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$106.72 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$88.66 ,$348.12 ,$147.20 
Outpatient Medical Services,VISIT CHARGES,99204,"NEW PATIENT OFFICE OF OTHER OUTPATIENT VISIT, TYPICALLY 45 MIN",760,$617.00 ,$524.45 ,85% of total billed charges,$475.09 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$563.49 ,429% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$587.13 ,447% BCBSTX Other fee schedule,$555.30 ,90% of total billed charges,$493.60 ,80% of total billed charges,$555.30 ,90% of total billed charges,$462.75 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$413.39 ,67% of total billed charges,$121.56 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$493.60 ,80% of total billed charges,$401.05 ,65% of total billed charges,$220.08 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$178.93 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$121.56 ,$587.13 ,$246.80 
Outpatient Medical Services,VISIT CHARGES,99205,"NEW PATIENT OFFICE OF OTHER OUTPATIENT VISIT, TYPICALLY 60 MIN",760,$823.00 ,$699.55 ,85% of total billed charges,$633.71 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$735.95 ,429% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$766.83 ,447% BCBSTX Other fee schedule,$740.70 ,90% of total billed charges,$658.40 ,80% of total billed charges,$740.70 ,90% of total billed charges,$617.25 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$551.41 ,67% of total billed charges,$164.53 ,105% of 2012 Medicare outpatient rates,,Not separately reimbursible per CMS guidelines,$658.40 ,80% of total billed charges,$534.95 ,65% of total billed charges,$293.56 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$238.67 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$164.53 ,$766.83 ,$329.20 
Outpatient Medical Services,VISIT CHARGES,99243,"PATIENT OFFICE CONSULTATION, TYPICALLY 40 MIN",760,$298.00 ,$253.30 ,85% of total billed charges,$229.46 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$415.70 ,429% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$433.14 ,447% BCBSTX Other fee schedule,$268.20 ,90% of total billed charges,$238.40 ,80% of total billed charges,$268.20 ,90% of total billed charges,$223.50 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$199.66 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$238.40 ,80% of total billed charges,$193.70 ,65% of total billed charges,$106.30 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$86.42 ,$433.14 ,$119.20 
Outpatient Medical Services,VISIT CHARGES,99244,"PATIENT OFFICE CONSULTATION, TYPICALLY 60 MIN",760,$380.00 ,$323.00 ,85% of total billed charges,$292.60 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$668.21 ,429% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$696.25 ,447% BCBSTX Other fee schedule,$342.00 ,90% of total billed charges,$304.00 ,80% of total billed charges,$342.00 ,90% of total billed charges,$285.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$254.60 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$304.00 ,80% of total billed charges,$247.00 ,65% of total billed charges,$135.55 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$110.20 ,$696.25 ,$152.00 
Outpatient Medical Services,VISIT CHARGES,99385,INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (18-39 YEARS),760,$180.00 ,$153.00 ,85% of total billed charges,$138.60 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$426.47 ,429% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$444.36 ,447% BCBSTX Other fee schedule,$162.00 ,90% of total billed charges,$144.00 ,80% of total billed charges,$162.00 ,90% of total billed charges,$135.00 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$120.60 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$144.00 ,80% of total billed charges,$117.00 ,65% of total billed charges,$64.21 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$52.20 ,$444.36 ,$72.00 
Outpatient Medical Services,VISIT CHARGES,99386,INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS),760,$185.00 ,$157.25 ,85% of total billed charges,$142.45 ,77% of total billed charges,,Not separately reimbursible per CMS guidelines,$518.83 ,429% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$540.60 ,447% BCBSTX Other fee schedule,$166.50 ,90% of total billed charges,$148.00 ,80% of total billed charges,$166.50 ,90% of total billed charges,$138.75 ,75% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,$123.95 ,67% of total billed charges,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$148.00 ,80% of total billed charges,$120.25 ,65% of total billed charges,$65.99 ,35.67% of total billed charges which is 123% of TX Medicaid OP CCR,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,,Not separately reimbursible per CMS guidelines,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,29% of total billed charges which is 100% of TX Medicaid OP CCR,$53.65 ,$540.60 ,$74.00 
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,Service Not Offered,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,Not applicable,,,